Organization Information

Please enter your Tax ID number. In some cases the Provider TAX ID is also a SSN.

An NPI that has been verified with IME and is associated with the tax id provided. The NPI entered must match an NPI that has appeared on a remittance advice statement for this tax id. If you are a service worker or case manager enter N/A

A transaction control number (TCN) from a PAID claim within the last eight weeks. The claim must be associated with the NPI entered above. If you do not bill Iowa Medicaid enter N/A

Please enter the USERNAME that you created on the IMPA Portal: https://secureapp.dhs.state.ia.us/impa/
Contact Information Of Person Completing This Form

First Name
Last Name

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Select this OPTION if just need access to complete an Incident Report.

Select this OPTION if you are the Provider Administrator for your TAD ID (Organization).


This Iowa Government information system is for authorized use only. Users have no expectation of privacy. Any use of this system implies consent to monitoring of any and all activities associated with its use. Unauthorized or improper use of the system may result in administrative disciplinary action and appropriate civil and criminal penalties under applicable law.
The form will be reviewed and approved or denied and an e-mail will be sent as soon as the process is complete to the address listed on the form. This should take no more than 2 business days. Thank you.