Prior Authorization


HOW are prior AUTHORIZATIONS HANDLED?

Once enrolled with your MCO, your Medicaid provider whether in-network or out-of-network must follow the MCO's PA requirements included in the health plans' Provider Manuals. Please work with your provider and MCO regarding any potential Prior Authorizations.
 
Pharmacy Drug Claim Prior Authorizations (PAs)
Pharmacy drug claim prior authorizations are processed differently than all other prior authorizations. All prescribers, whether in-network or out-of-network, must follow the MCOs' pharmacy drug prior authorization requirements included in the health plans Provider Manuals. Drug claims requiring prior authorization will not be processed by the MCOs if there is not an approved prior authorization in place. Providers should continue to follow the IME pharmacy drug prior authorization policies and processes for the Fee-for-Service members.
 
Other Prior Authorizations
All existing prior authorizations for newly enrolled managed care members will be honored for the first 30 days or as otherwise determined by the health plan.
 

WHAT IS THE TURNAROUND TIME FOR PRIOR AUTHORIZATIONS?

Prior authorizations must be handled within 7 days, though most will likely be turned around in just a few days or less.
Pharmacy prior authorizations will be processed within 24 hours of the provider's PA submission.
 

WHAT IS THE DIRECT NUMBER FOR PRIOR AUTHORIZATIONS?

  • Amerigroup: 1-800-454-3730
  • UnitedHealthcare: 1-888-650-3462

 

 
Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.)
1-800-338-8366 (Toll Free) 
515-256-4606 (Des Moines Area)
515-725-1351 (Fax)
 
For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.
 
Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.