Medical Billing Company in Iowa | Wellmark Expertise

IA Health Link, Iowa's Medicaid managed care program, has covered most Medicaid beneficiaries since April 1, 2016, integrating physical, behavioral, and long-term care into a single managed care structure. About 95 percent of members are enrolled in one of Iowa's three MCOs, Amerigroup Iowa, Iowa Total Care, and Molina Healthcare of Iowa, while the remaining 5 percent stay on fee-for-service. Iowa's Children's Health Insurance Program, known as Hawki, runs separately from IA Health Link, and the MCO roster has seen real turnover: both UnitedHealthcare and AmeriHealth Caritas exited the program in 2017.

On the commercial side, Wellmark Blue Cross and Blue Shield is overwhelmingly dominant, with market share running as high as 90 percent in the individual market and roughly 78 to 81 percent in the group markets, according to Iowa Insurance Division data. Wellmark, based in Des Moines, also serves South Dakota, and a rival nonprofit co-op that tried to compete with it, CoOportunity Health, collapsed into state receivership within two years of launching. For most Iowa practices, understanding Wellmark's billing rules is close to understanding the entire commercial market.