Administrative Policies & Procedures
I am:

Detailed information for Section 6 of the Provider Reference Guide

To access a policy, click on the link.

Advance Directives
Appeals/Grievance Procedure for Commercial Members – Iowa
Appeals/Grievance Procedure for Commercial Members – Illinois
Appeals/Grievance Procedure for Commercial Members – Wisconsin
Appeals/Grievances Procedure for State of Wisconsin Employer Group WISE
Appeal Procedures for Commercial Members – Wisconsin
Authorization and Referral Management
Criteria Used for Determining Medical Necessity
Drug Formulary
Emergency Transportation
Fair Hearing and Appellate Review
Medicare Appeals/Reconsideration for Pre-Service (standard) and Post-Service (standard)
Medicare Appeals/Reconsideration for Pre-Service (expedited)
Members Rights & Responsibilities
Mental Health/Chemical Dependency Access Standard
Notifications Process for Medicare Members Who No Longer Meet Medicare Criteria
Notification to Providers/Practitioners/Members/Employees on Appropriateness of Utilization
Protocol for Obtaining Approval of Vaccines/Immunizations covered by MAHP
Satisfaction Surveys
Standards for Access to Care and Service
Utilization Review Policy