IA HF636

Dental carriers cannot deny claims for dental care services that were previously approved through prior authorization, and must reimburse providers at the contracted rate for authorized services

Prior authorization is defined as a dental carrier's determination that a specific dental care service proposed by a provider for a covered person will be reimbursed at a specified amount, subject to applicable coinsurance or deductibles

Carriers may deny claims despite prior authorization under specific exceptions, including: benefit limitations reached after authorization, documentation failing to support the claim, changes in the patient's dental condition making services no longer medically necessary, fraudulent claims, or patient ineligibility

The bill's requirements cannot be waived by contract, and any contract provision contrary to these requirements is null and void

The Commissioner of Insurance may adopt administrative rules to implement the law