Iowa Medicaid Portal Access (IMPA) System Document Upload Access

This form is for use by providers to request access to upload supporting documents for electronic claims using the IMPA system.

Provider Information:
Contact Information of Person Completing the Form:
If no email: Put 'NA'
Certification Statement and Signature

* Sign this form electronically by typing your name and the date.
After completing this registration form, please submit the form by clicking on the “SUBMIT” button below.

If you have any questions please email 

470-5552 (11/18)