The bill establishes a new section regarding prior authorization for dental care services in Iowa. It mandates that dental carriers cannot deny claims for dental services that have been approved through prior authorization. Additionally, dental carriers are required to reimburse dental care providers at the contracted rate for services rendered to covered persons based on prior authorization. The bill defines key terms such as "covered person," "dental care provider," "dental carrier," and "prior authorization," ensuring clarity in the application of these provisions.
However, the bill also outlines specific exceptions under which a dental carrier may deny reimbursement for services that were previously authorized. These exceptions include situations where benefit limitations have been reached, where documentation does not support the claim, or where changes in the patient's dental condition affect the medical necessity of the services. Importantly, the bill prohibits any contractual waivers of these requirements, rendering any conflicting agreements null and void. The commissioner of insurance is granted the authority to adopt rules for the administration of this section.