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If you can provide information specific to Iowa Total Care, please answer the following questions:

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1. Average Visits Per Episode?

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2. # of denials separated by full denial or partial denial (full denial means all visits denied, partial means you asked for X and got less than X but more than 0)

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3. When partial denial occurs, what % of the visit request is granted?

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4. Reasons for denial by count

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5. Amount of time required to comply with prior auth requirements per request

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6. Any additional information on administrative burden impacting cost of delivering care

If you can provide information specific to Wellpoint, please answer the following questions:

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7. Average visit per episode?

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8. # of denials separated by full denial or partial denial (full denial means all visits denied, partial means you asked for x and got less than x but more and 0)

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9. When partial denial occurs, what % of the visit request is granted

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10. Reasons for denial by count

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11. Amount of time required to comply with prior auth requirements per request

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12. Any written information on administrative burden impacting cost of delivering care

Member Information

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13. First Name (Required.)

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14. Last Name (Required.)

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15. Email Address (Required.)

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16. Phone Number (Required.)

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