Clinical & Reimbursement Policies
Additional policies supporting health plan operations, compliance, or administration may also be published here as appropriate. New medical policies will be available for download and review in the MyCare portal after the effective date.
Waiver Forms
This secure form should be used to request Transition of Care (TOC) or Continuity of Care (COC) if your Provider is no longer contracting with Mountain Health Co-Op and you believe you are eligible for Transition of Care benefits. It can be completed by the member, but requires a provider signature.
Use this form to request out-of-network care.
Sort by Category
Category
Policy ID
Name
Effective Date
Revision Date
Next Review Date
Reimbursement
REIMB_001
January 1, 2026
October 25, 2025
October 25, 2026
Reimbursement
REIMB_032
January 1, 2026
November 23, 2025
November 23, 2026
Reimbursement
REIMB_039
January 1, 2026
October 27, 2025
October 27, 2026
Reimbursement
REIMB_040
January 1, 2026
October 27, 2025
October 27, 2026
Reimbursement
REIMB_042
January 1, 2026
October 29, 2025
October 29, 2026
Reimbursement
REIMB_043
January 1, 2026
October 13, 2025
October 13, 2026
Reimbursement
REIMB_044
January 1, 2026
October 13, 2025
October 13, 2026
Reimbursement
REIMB_045
January 1, 2026
November 24, 2025
November 24, 2026
Reimbursement
REIMB_034
January 1, 2026
November 3, 2025
November 3, 2026
Reimbursement
REIMB_036
January 1, 2026
October 13, 2025
October 13, 2026
Reimbursement
REIMB_037
January 1, 2026
October 27, 2025
October 27, 2026
Reimbursement
REIMB_046
January 1, 2026
October 13, 2025
October 13, 2026
Reimbursement
REIMB_002
September 1, 2024
September 1, 2024
October 1, 2027
Reimbursement
REIMB_004
September 1, 2024
July 11, 2024
July 11, 2026
Reimbursement
REIMB_007
September 1, 2024
July 1, 2024
July 1, 2026
Reimbursement
REIMB_011
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_017
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_017
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_019
September 1, 2024
July 18, 2024
October 1, 2026
Reimbursement
REIMB_020
September 1, 2024
July 18, 2024
October 1, 2026
Reimbursement
REIMB_021
September 1, 2024
June 1, 2024
June 1, 2026
Reimbursement
REIMB_022
September 1, 2024
June 1, 2024
June 1, 2026
Reimbursement
REIMB_023
September 1, 2024
July 16, 2024
October 1, 2026
Reimbursement
REIMB_025
September 1, 2024
July 16, 2024
October 1, 2026
Reimbursement
REIMB_026
September 1, 2024
July 16, 2024
October 1, 2026
Reimbursement
REIMB_027
September 1, 2024
July 16, 2024
July 16, 2026
Reimbursement
REIMB_029
September 1, 2024
August 1, 2024
October 1, 2026
Reimbursement
REIMB_031
May 1, 2025
May 1, 2025
October 1, 2026
Reimbursement
REIMB_050
January 1, 2026
March 9, 2026
March 9, 2027
Administrative
ADMIN_008
July 15, 2024
November 24, 2025
November 24, 2026
Administrative
ADMIN_014
July 17, 2024
December 8, 2025
December 8, 2026
Administrative
ADMIN_015
July 1, 2025
November 24, 2025
November 24, 2026
Administrative
ADMIN_017
January 1, 2026
October 27, 2025
October 27, 2026
Administrative
ADMIN_018
January 1, 2026
October 27, 2025
October 27, 2026
Medical
MM_094
January 1, 2026
January 5, 2025
January 5, 2026
Medical
MM_096
January 1, 2026
November 24, 2025
November 24, 2026
Medical
MM_0101
February 17, 2026
January 5, 2026
February 17, 2028
Medical
MM_002
August 9, 2024
February 25, 2026
February 25, 2027
Medical
MM_001
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_007
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_009
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_010
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_011
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_012
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_013
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_016
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_019
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_022
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_024
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_023
September 1, 2024
March 23, 2026
March 23, 2027
Medical
MM_0103
September 1, 2024
March 23, 2026
March 23, 2027
Medical
MM_025
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_026
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_030
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_031
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_032
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_035
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_037
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_036
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_038
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_034
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_039
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_040
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_041
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_042
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_043
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_044
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_045
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_048
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_050
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_053
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_054
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_061
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_062
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_065
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_070
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_071
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_073
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_078
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_075
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_081
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_082
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_083
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_084
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_0104
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_0105
September 1, 2024
April 27, 2026
April 27, 2027