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ITC Changes Prior Auth Policy

Wednesday, July 17, 2019   (0 Comments)
Posted by: Carl Lingen
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Iowa Total Care Changes Prior Authorization Policy


Effective immediately,Iowa Total Care is changing its prior authorization requirements for chiropractic services. The new policy requires a notification within 2 business days for chiropractic manipulation services for in-network providers. Iowa Total Care will monitor services in compliance with the following State guidelines:

  • Category I diagnoses (12 manipulations per 12 month period)
  • Category II diagnoses (18 manipulations per 12 month period)
  • Category III diagnoses (24 manipulations per 12 month period)
  • Diagnostic combinations between categories is 28 manipulations per 12 month period

The notification must be completed in order for the claim to be paid. To submit a notification, contact Iowa Total Care at:

  • Fax: 1-833-257-8327
  • Phone: 1-833-404-1061 Option #3 then Option #5 for Medical Authorizations

This notification must include:

  • Start and end date
  • Number of treatments
  • Must include diagnosis

Note: For a fax notification:

  • Providers may use the standard outpatient prior authorization form, or
  • A form of your choosing or that is generated from your billing system and meets the above requirements, or
  • ICS Medicare and Medicaid Committee is working on a notification form specific for chiropractors and will be releasing it soon.

Failure to submit a notification may result in delayed or nonpayment from ITC.(Please note, that a notification is not a prior authorization.)

The notification is currently required by ITC. ICS will continue discussions with ITC in attempts to reduce this administrative burden.

ICS would like to thank our consultants, legal team, legislative liaison and executive committee for their continued work on this issue. If you have any further questions, please contact us.

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