Iowa HF2438 regulates health carriers and utilization review organizations, setting standards for audits, prior authorizations, and claim payments.

Iowa HF2438 establishes regulations for health carriers and utilization review organizations, focusing on audits, prior authorizations, and claim payments. The bill mandates that health carriers must either accept and pay or deny a clean claim within 30 days of receiving an electronic claim or 45 days for paper claims. Insurers cannot retroactively deny, reduce, or recoup payments unless the claim was misrepresented, fraudulent, or a duplicate. If a health carrier conducts an audit of a clean claim, it must reimburse the provider for reasonable administrative costs.

Iowa HF2438 regulates health carriers and utilization review organizations, setting standards for audits, prior authorizations, and claim payments.

Iowa HF2438 establishes regulations for health carriers and utilization review organizations, focusing on audits, prior authorizations, and claim payments. The bill mandates that health carriers must either accept and pay or deny a clean claim within 30 days of receiving an electronic claim or 45 days for paper claims. Insurers cannot retroactively deny, reduce, or recoup payments unless the claim was misrepresented, fraudulent, or a duplicate. If a health carrier conducts an audit of a clean claim, it must reimburse the provider for reasonable administrative costs.