Care Management
Care Management facilitates improved health outcomes and wellness for Medical Mutual members. We focus on ensuring and facilitating the delivery of medically necessary, high quality, cost-effective healthcare services in the most appropriate setting. In addition we strive to provide information and tools to our constituents that will empower members, support providers and manage healthcare trends for our employer groups.
Available Resources
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2009 Prior Approval and Investigational Services
List of services that require prior approval or are considered investigational.
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Clinical Quality
Medical Mutual recognizes the adoption and utilization of clinical practice guidelines that have been developed by our network providers as one way of achieving better health for our members.
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Discharge Planning
Convenient discharge instructions for patients, families and all individuals and organizations responsible for providing continuing care.
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Medical Necessity Criteria
Guidelines used for evaluating whether a service is medically necessary.
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Corporate Medical Policies
Medical Mutual’s guidelines for determining coverage for specific procedures, therapies, devices and services.
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Patient Safety
Medical Mutual works to educate our members and work with you to improve the safety of all hospitalized patients through the implementation of programs and initiatives.
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Rx Benefit Management
Medical Mutual’s guide to prescription formulary, pharmaceutical education, prior authorization, clinical services and home delivery practices.