Health insurance trade practices, audits, prior authorizations, and utilization review organizations.

The bill amends Iowa's insurance laws to establish standards for health carriers and utilization review organizations. It mandates that health carriers either accept and pay or deny clean claims within 30 days of receiving an electronic submission or 45 days for paper submissions. Health carriers must reimburse providers for administrative costs related to audits and cannot retroactively deny, reduce, or recoup payment unless specific conditions are met.

Health insurance trade practices, audits, prior authorizations, and utilization review organizations.

The bill amends Iowa's insurance laws to establish standards for health carriers and utilization review organizations. It mandates that health carriers either accept and pay or deny clean claims within 30 days of receiving an electronic submission or 45 days for paper submissions. Health carriers must reimburse providers for administrative costs related to audits and cannot retroactively deny, reduce, or recoup payment unless specific conditions are met.