The bill establishes a new section regarding prior authorization for dental care services in Iowa. It mandates that dental carriers cannot deny claims for services that have been approved through prior authorization, and they must reimburse dental care providers at the contracted rate for those services provided to covered persons. The bill defines key terms such as "covered person," "dental care provider," "dental care services," "dental carrier," and "prior authorization," ensuring clarity in the application of these provisions.
However, the bill 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, documentation fails to support the claim, changes in the patient's dental condition occur, or if the claim was submitted fraudulently. Additionally, the bill prohibits any contractual waivers of these requirements, rendering any conflicting contracts null and void. The commissioner of insurance is granted the authority to adopt rules for the administration of this section.