IA HSB183

Dental carriers cannot deny claims for dental care services that were previously approved through prior authorization

Dental carriers must reimburse providers at the contracted reimbursement rate for services provided per a prior authorization, subject to applicable coinsurance or deductibles

Exceptions allowing claim denial include: benefit limitations reached after authorization, documentation not supporting the claim, changes in patient dental condition making services no longer medically necessary, fraudulent claims, or patient ineligibility at time of service

Contracts that attempt to waive these prior authorization requirements are null and void

Commissioner of Insurance may adopt rules to administer these provisions