The Healthy and Well Kids in Iowa (hawk-i) Program generally provides free or low-cost health, prescription drug, and dental benefits to Iowa children in families whose income falls between 167 and 302 percent of the federal poverty level.
How to submit hawk-i claims and inquiries
Wellmark’s contract with the Iowa Department of Human Services (DHS) to administer hawk-i claims terminated on Dec. 31, 2015. The information below identifies how providers should submit claims for Wellmark hawk-i enrollees for dates of service through Dec. 31, 2015. Note: Timely filing and adjustment timeliness guidelines have not changed.
Please continue to submit hawk-i claims for dates of service up to and including Dec. 31, 2015, to Wellmark. To be considered for reimbursement, claims must be received within 180 days from the date of service for professional provider services or discharge date for inpatient admissions. Dates of service on or after Jan. 1, 2016, should be submitted to the carrier indicated on the hawk-i member’s ID card effective for those dates of service.
If the member was an inpatient (i.e., receiving inpatient care in a hospital or nursing facility) on Dec. 31, 2015, and discharged in 2016, facility benefits for the inpatient stay will be administered through Wellmark for the lesser of 60 days or the member’s facility discharge date. The extension for these split claims applies only to facility-related services. For more guidance on inpatient dates of service that span years, please refer to the Claims Filing section of the Provider Guide.
Professional provider services are driven by date of service; therefore, professional claims for services rendered on and before Dec. 31, 2015, should be submitted to Wellmark. For services on Jan. 1, 2016, and after, please submit to the member’s new carrier.
Both practitioners and facilities have 18 months from the date of the original Wellmark remittance to submit a change on a claim or request a claim review. Please start by finding your claim in the Check a Claim tool. Then select “Inquire or Submit Documents on this Claim” from the drop-down menu. For more information about this process, please visit the Appeals and Inquiries page.