Bill > HF636

This bill establishes new regulations for prior authorization in dental care services, requiring dental carriers to reimburse dental care providers for services that have been pre-approved through a prior authorization process. Specifically, a dental carrier cannot deny a claim for a pre-authorized dental service unless certain specific exceptions apply, such as when a patient's benefit limitations have been reached, the documentation does not support the original authorization, the patient's dental condition has changed, another payer is responsible for payment, the claim was fraudulent, or the provider is no longer in the carrier's network. The bill defines key terms like "prior authorization" as a carrier's determination about whether a proposed dental service will be reimbursed, and it prohibits carriers from waiving these requirements through contracts. The commissioner of insurance is granted the authority to adopt rules to implement the bill, which aims to provide more transparency and reliability in the dental care reimbursement process by limiting a carrier's ability to deny claims that were previously pre-authorized.

Business and Industry

Commerce (H)

https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF636