Medical Mutual - Health Plans for Life

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

  • 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.

  • Corporate Medical Policies

    Medical Mutual's guidelines for determining coverage for specific procedures, therapies, devices and services.

  • Discharge Planning

    Convenient discharge instructions for patients, families and all individuals and organizations responsible for providing continuing care.

  • Medical Drug Management

    Beginning October 1, 2012, Medical Mutual will require National Drug Code (NDC) identifiers to be submitted on professional and outpatient claims when billing for select medications.

  • Medical Necessity Criteria

    Guidelines used for evaluating whether a service is medically necessary.

  • 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.

  • Prior Approval & Investigational Services

  • Rx Benefit Management

    Medical Mutual's guide to prescription formulary, pharmaceutical education, prior authorization, clinical services and home delivery practices.

ACIP Immunization Schedule Resources

The Centers for Disease Control and Prevention periodically update their immunization schedules. Please select the following links for current information.

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