Form 470-5479 Wraparound Payment Request Access for the Iowa Medicaid Portal Access (Impa) System - Iowa

Form 470-5479 Wraparound Payment Request Access for the Iowa Medicaid Portal Access (Impa) System - Iowa

What Is Form 470-5479?

This is a legal form that was released by the Iowa Department of Human Services - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is form 470-5479?
A: Form 470-5479 is a Wraparound Payment Request Access form for the Iowa Medicaid Portal Access (IMPA) System.

Q: What is a Wraparound Payment Request?
A: A Wraparound Payment Request is a request foradditional payment for services offered to Medicaid recipients that are not covered by the Medicaid program.

Q: Who can access the IMPA System?
A: Individuals and organizations that provide Medicaid services in Iowa can access the IMPA System.

Q: Why would someone need to submit Form 470-5479?
A: Form 470-5479 needs to be submitted to request access to the Wraparound Payment Request feature in the IMPA System.

Q: Is there a fee for accessing the IMPA System?
A: No, there is no fee for accessing the IMPA System.

Q: What information is required on Form 470-5479?
A: Form 470-5479 requires basic information about the individual or organization requesting access, as well as a certification statement and signature.

Q: How long does it take to process Form 470-5479?
A: The processing time for Form 470-5479 may vary, but it generally takes a few weeks for access to be granted.

Q: Who can I contact for more information about Form 470-5479?
A: For more information about Form 470-5479 and the IMPA System, you can contact the Iowa Medicaid program.

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Form Details:

  • Released on May 1, 2017;
  • The latest edition provided by the Iowa Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 470-5479 by clicking the link below or browse more documents and templates provided by the Iowa Department of Human Services.

Download Form 470-5479 Wraparound Payment Request Access for the Iowa Medicaid Portal Access (Impa) System - Iowa

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