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You are required to update the Iowa DHS Point of Sale Agreement you previously had completed (see IME Informational Letter #419 for more information).
You have two options to update this information. You may: a) fill out and submit an email acknowledgment as detailed below. All you need to do is click the link and include your provider number, the date and agree to the POS agreement; or b) fill out the linked form and mail it to:
IME POSTHIS AGREEMENT, by and between the Division of Medical Services of the Iowa Department of Human Services, hereinafter called the "Department," acting in its own right as the Agency responsible for administering the Medical Assistance Program (Title XIX) and you, hereinafter called "Provider".
WITNESSETH:
In consideration of the mutual promises and covenants contained herein and other good and valuable consideration, the parties agree as follows:
To submit your Point of Sale Agreement, please email info@iowamedicaidpos.com and include your name, email address and provider number. By sending this email, you acknowledge that you have thoroughly read the above agreement, that you have had the opportunity to consult counsel as necessary for you to form a complete understanding of all rights and obligations contained in the agreement, and that you freely accept and agree to be bound by the terms of the agreement.