Authorization Table

• Certain groups may have specific authorization requirements. Before using this tool, verify current member benefits .

 

• If you are a contracted Durable Medical Equipment provider, a non-contracted provider, or a provider outside of Iowa and South Dakota, click here.

 

• For information specific to Federal Employee Program (FEP) members, click here.

 

• Preauthorization is not required for members receiving out-of-area diagnostic imaging services.

 

• All services subject to precertification also will require concurrent review. See Authorization page for definition of pre-service review terms.

If a service or procedure is not found on the Authorization Table this means that the service does not require any form of pre-service review, and no medical policy exists for that procedure. Therefore, no member or provider submission or action is needed.

Effective Dec. 15, 2012, prior approval (PA) is now required for all designated services/procedures located on the Authorization Table. If the PA is not approved or not completed prior to the service being provided, all claims for the procedure will be denied (this includes hospital, practitioner, and ancillary claims). If the PA is approved, the provider will receive an authorization number that must be submitted on all claims associated with the procedure. The member and provider inquiry and appeals process will remain unchanged.

Receiving an authorization number does not guarantee the member has benefits for the service. Payment is based on the member's eligibility and plan coverage when the service is provided.