Navigating the complexities of healthcare authorizations can be challenging for providers. Iowa Total Care offers resources to streamline this process, and understanding the Iowa Total Care Auth Tool is crucial for efficient practice management. This guide provides a comprehensive overview of the tool, helping you determine when prior authorization is necessary and how to utilize it effectively.
Understanding the Pre-Auth Needed Tool
Iowa Total Care’s Pre-Auth Needed Tool is designed to assist healthcare providers in quickly verifying whether a service requires prior authorization for Iowa Total Care members. This online resource is intended to simplify the administrative process and ensure timely patient care.
Important Disclaimer:
While Iowa Total Care strives to provide the most up-to-date information through the Pre-Auth Needed Tool, it’s important to understand its limitations. The tool does not guarantee claim payment. Payment is contingent upon member eligibility, covered benefits, provider contracts, accurate coding, and proper billing practices. Always consult the provider manual for detailed guidelines. If you remain uncertain about the necessity of prior authorization, submitting a request is recommended to ensure accuracy and avoid potential claim issues.
Verifying Services with External Partners
For certain specialized services, authorization verification is handled by Iowa Total Care’s external partners. Please use the following resources for these specific service types:
- Vision Services: Verification for vision services is managed by Envolve Vision. Please visit Envolve Vision for inquiries.
- Dental Services: Dental service verification is handled by the Department of Human Services. Refer to the Department of Human Services Dental Wellness Plan for more information.
- Advanced Imaging (MRA, MRI, PET, CT Scans): Prior authorization for MRA, MRI, PET, and CT scans is managed by NIA (National Imaging Associates). Use the NIA RadMD website to verify requirements.
- Cardiac Services (Participating Providers, Members 18+): For cardiac services for participating providers and members 18 years and older, please verify requirements through New Century Health (now Evolent Health). Access their portal at Evolent Health.
Prior Authorization Requirements for Non-Participating Providers
Non-participating providers should be aware that prior authorization is required for the majority of services. It is crucial to utilize the code checker tool (detailed below) to confirm authorization needs. For non-participating providers interested in joining the network, please visit Join Our Network.
Emergency Department, Urgent Care, and Family Planning Services
Services administered in the Emergency Department or Urgent Care Center, as well as Family Planning services billed with a Contraceptive Management diagnosis, do not require prior authorization.
Quick Reference Table: Does My Service Need Prior Authorization?
The following table provides a quick guide to common service scenarios to help determine if prior authorization is needed.
| Type of Service | Prior Authorization Required? |
|---|---|
| Inpatient Facility Admissions | YES |
| Anesthesia Services for Pain Management | YES |
| Oral Surgery Services Provided in the Office | YES |
| Home Services (excluding DME, orthotics, prosthetics, supplies, in-home IV Therapy, home birth, sleep studies) | YES |
| Hospice Services | YES |
Using the Service Code Checker
For specific service verification, Iowa Total Care provides a service code checker. This tool allows you to enter the code of the service in question and quickly determine if prior authorization is mandated.
Submitting a Prior Authorization Request
If the service requires prior authorization, you can easily submit a request through the Iowa Total Care provider portal.
Ready to Submit? Login Here to access the authorization submission portal.
Conclusion
The Iowa Total Care Auth Tool is a valuable resource for providers to efficiently manage prior authorization requirements. By understanding its functionality and utilizing the provided resources, you can streamline your administrative processes, ensure compliance, and focus on delivering quality patient care. Remember to always verify specific service requirements and consult the provider manual for complete details.
