Iowa Medicaid POS

Iowa DHS Point of Sale Agreement

Click to view printable version.

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:

1305 East Walnut Street
Des Moines, Iowa 50319-0114


THIS 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".


In consideration of the mutual promises and covenants contained herein and other good and valuable consideration, the parties agree as follows:

  • The Department shall allow the Provider to submit claims to IME POS through Point of Sale (P.O.S.).
  • In utilization of claims entry through P.O.S., the Provider shall safeguard the Medicaid program against abuse.
  • The Provider shall correctly enter the claims data, monitor the data, and certify that the data is correct.
  • The Provider shall allow the Department access to all claims data and will assure that the transmission of claims data is restricted to authorized personnel; thus precluding erroneous payments by the Department's Fiscal Agent as a result of carelessness or fraud.
  • At the time of transmission of claims, the Provider shall have on file applicable source data in accordance with existing program requirements, i.e. charge data.
  • The Provider shall allow the Division of Medical Services or any of its designees and representatives to review and copy all records, including source documents and data which relate to information entered for the Medicaid Program.
  • The Provider shall abide by all Federal and State statutes, rules, regulations, and manuals governing the Iowa Medicaid Program and those conditions as set out in the Medical Assistance Provider Agreement entered into previously.

To submit your Point of Sale Agreement, please email 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.