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Iowa Department of Health and Human Services (Centralized Facility Eligibility Unit, Imaging Center #1) fax number

(515) 564-4040

Centralized Facility Eligibility Unit – Imaging Center #1 (Council Bluffs, IA)

Used for: Submitting Medicaid/IME eligibility-related documents and case activity reports to DHS (e.g., Case Activity Report Form 470-0042) and related facility communications.

Fax destination details

Department
Centralized Facility Eligibility Unit – Imaging Center #1 (Council Bluffs, IA)
Purpose
Submitting Medicaid/IME eligibility-related documents and case activity reports to DHS (e.g., Case Activity Report Form 470-0042) and related facility communications.
Form
470-0042 — Case Activity Report
Address
Centralized Facility Eligibility Unit – Imaging Center #1, 417 E Kanesville Blvd, Council Bluffs, IA 51503-4470
Voice phone
877-344-9628

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.

Complete sections 1–3 (and 4 if applicable for PMIC/Medicare). Then mail, email, or fax a copy to the DHS Centralized Facility Eligibility Unit, Imaging Center #1. Include required data such as resident name, dates, facility, and level of care.

Review official form instructions

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