The bill establishes regulations 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," and "prior authorization," ensuring clarity in the application of these regulations.
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, documentation discrepancies, changes in the patient's dental condition, or if the provider has already been compensated for the services. Additionally, 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.