Department of Human Services of Iowa fax number

Fax destination details

Department

Iowa Medicaid Enterprise – Member Services (Iowa Department of Health and Human Services)

Purpose

Billing inquiries, Medically Exempt requests (Medically Exempt Member Survey and Medically Exempt Attestation and Referral Form), and other Iowa Medicaid Member Services communications

Form

Medically Exempt Attestation and Referral Form — Medically Exempt Attestation and Referral Form

Address

Iowa Medicaid Member Services, Lucas Building, 321 East 12th Street, Des Moines, IA 50319

Voice phone

1-800-338-8366

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Submit the Medically Exempt Attestation and Referral Form by mail or fax to IME Member Services (Attn: Medically Exempt). Mail: Iowa Medicaid Enterprise Member Services (Attn: Medically Exempt), PO Box 36510, Des Moines, IA 50315; Fax: 515-725-1351; Email: IMEmemberservices@dhs.state.ia.us

Official form instructions are published as a downloadable file on the organization's website.