Provider Forms

Financial and Statistical Report for Home Health Agencies (HHA) who provide Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Private Duty Nursing and Personal Care Services (PDN/PC).
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RSP Cost Report
Financial and Statistical Report for Remedial Services Provider Identification Page

RSP Parent Cost Report
Financial and Statistical Report for Remedial Services Provider Identification Page (Parent)

CMHC Cost Report
Community Mental Health Center Financial & Statistical Report
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FQHC
Federally Qualified Health Center (FQHC)

Hab. Svcs. - FS
Habilitation Services Financial and Statistical Report

Hab. Svcs. - Parent
Habilitation Services Parent Cost Report

Hospital
Hospital - Not Critical Access

Financial & Statistical Report
Nursing Facility (NF) / Intermediate Care Facility for the Intellectually Disabled (ICF/ID) / Residential Care Facility (RCF)
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PMIC
Psych Medical Institution for Children (PMIC)
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RHC - Hospital Based
Rural Health Clinic (RHC) - Hospital Based

RHC - Freestanding
Rural Health Clinic (RHC) - Freestanding

MHI
State Mental Health Institute (MHI)

Case Management
Targeted Case Management (TCM) Cost Report Template

Cooperative Agreement

• LEA Agreement
  The purpose of this agreement is to assure the implementation of 34 CFR 300.
  I/T Contract
  The purpose of this agreement is to assure the implementation of 34 CFR 303.

PC-ACE Pro32 Help Documents

• Installation & Update Files
  • Install PC-ACE
  • Update PC-ACE
  • PC-ACE Professional Change Summary for Version NHS 24.01 (6.1)
  • PC-ACE Institutional Change Summary for Version NHS 24.01 (6.1)
  • Install Adobe Acrobat Reader
  • PC-ACE User Guide Version (Version 6.1)
    • *NOTE: Certain portions of this document may not pertain to the version of PC-ACE provided by EDISS.
    • Professional Claims - CMS1500
    • Professional Claims - Waiver-TCM
    • Professional Claims - Dental
    • Institutional Claims - UB04
    • Institutional Claims - Nursing Facility
    • Third Party Liability (TPL) Claims
    • Trainings & Tutorials

    Iowa Provider Cost Audit Web Portal Forms

    • Iowa Provider Cost Audit Web Portal Registration Form
    • Iowa Provider Cost Audit Web Portal External User Guide

    Department of Corrections Forms

    • Managed Care Organization Enrollment