Prior Authorization Requirements
From April 1-30, 2016, no prior authorizations (PAs) will be required, except for pharmacy drug claims.
During the first 90 days of the transition, all existing prior authorizations will be honored. During this 90-day grace period, providers will be able to establish new authorizations following the policies of the member's selected MCO.
Medicaid providers, whether in-network or out-of-network, must follow the MCO's PA requirements included in the health plans' Provider Manuals. The MCO's Provider Manuals were recently updated and can be found
here.
The Iowa Medicaid Enterprise (IME) has put together a PA summary by plan. Quickly view and compare PA requirements for each plan with this easy-to-use chart.
Download and print the PA requirements by plan
here
.
Informational Letter 1628-MC provides important direction on the PA process during this transition. Please read it carefully. It can be found here.
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