Medical Mutual - Health Plans for Life

Documentation Standards, Forms and Policies

Consistent, current, legible and complete documentation is an essential component in quality patient care. A practitioner should be able to act on the patient’s behalf based on the medical record documentation information. With this goal in mind, Medical Mutual encourages practitioners to strive for compliance with the documentation standards, and provides the forms and policies below to assist in these efforts.

Office Site and Medical Record Documentation Standards

Home Health Care Request Forms

These customized fax forms are for Home Health Care requests only. They are designed to assure all necessary information for correct and accurate processing is supplied to Medical Mutual.


Imaging Procedure Request Forms

MRI/MRA and PET scan prior approval phone requests are not accepted by Medical Mutual. Providers with imaging requests may choose to submit through Reviewlink the Company's efficient and secure web-based certification program, or via fax using the appropriate imaging fax form below. These forms are not adapted as fillable forms. You will need to print and manually fill out these forms.

acrobatTo view the PDF files, or if you encounter an error opening the PDF files on this site, download and install the latest free version of Acrobat Reader.

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