What is prior authorization?
Prior authorization (PA)—also called preauthorization—means the health plan must approve certain care before it will cover it. Doctors or hospitals often submit PA for you, but you still have rights if PA is denied.
A PA denial is different from a bill denial after care already happened. With PA, the fight is usually about whether the plan will allow the treatment at all.
Overview for any state: Prior authorizations. This page is Iowa-only.
Confirm plan type: Iowa: Start Here.
Iowa PA rules
Iowa regulates PA through Iowa Code chapter 514F (utilization review) and Iowa Administrative Code rules for health carriers. Which rule applies depends on whether your plan is a regulated Iowa health carrier, a utilization review organization, or Medicaid.
Utilization review organizations (Iowa Code 514F.8)
House File 303 (effective July 1, 2025) added turnaround requirements for utilization review organizations, including:
- Urgent: determination within 48 hours after receipt
- Non-urgent: within 10 calendar days after receipt
- Complex or high-volume non-urgent: up to 15 calendar days
- Receipt notice: within 24 hours, the organization must acknowledge or provide receipt to the provider
Statute: Iowa Code § 514F.8. Related provisions in § 514F.4 address annual review to reduce PA on routinely approved services.
Health carriers (IAC 191-79.3)
For many IDOI-regulated health carriers and pharmacy benefit managers:
- Non-urgent: approve or deny within 5 calendar days after receipt
- Urgent: within 72 hours
- If the carrier does not act within those limits on a completed request, PA may be deemed granted
- Approved PA is generally valid at least 12 months (or a clinically appropriate shorter period)
Rule: Iowa Admin. Code r. 191-79.3.
Marketplace (QHP) prescription drugs
Qualified health plans must meet federal expedited review standards (often 24 hours for exigent pharmacy requests under 45 CFR 156.122), as referenced in Iowa admin rules.
Keep proof
Save dates when your provider submitted PA, when the plan asked for more records, and every written response. Deadlines often start when the plan has all necessary information, not when you first called.
Where to look up PA rules
PA is handled by the issuer on the ID card. Common Iowa Marketplace and commercial carriers:
- Wellmark: wellmark.com
- Medica: medica.com
- UnitedHealthcare: uhc.com
- Oscar: hioscar.com
- Avera Health Plans: avera.org — health plans
- Ambetter / Iowa Total Care: ambetterhealth.com
Shop Marketplace plans at HealthCare.gov.
Iowa Medicaid
Medicaid PA follows MCO or fee-for-service rules, not only chapter 514F. For non-MCO services, Iowa admin rules can require PA decisions within 24 hours (IAC 441-79.8). Appeals: MCO first, then HHS fair hearing — HHS appeals.
If PA is denied
- Get the denial in writing with reasons and appeal instructions.
- Ask the treating clinician for records and a medical-necessity letter.
- File an internal appeal by the deadline — Iowa internal appeals.
- If still denied, consider external review through IID for eligible plans.
Urgent care
Use the 48-hour (514F.8) or 72-hour (191-79.3) urgent PA rules, whichever applies to your plan type. For urgent denials, ask the plan for an expedited internal appeal and, if needed, expedited external review (Iowa external review). For expedited external review, IID asks you to call 877-955-1212 before sending paperwork so staff can direct the fastest submission path.