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
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_038
January 1, 2026
October 27, 2025
October 27, 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_033
January 1, 2026
October 29, 2025
October 29, 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_041
January 1, 2026
October 27, 2025
October 27, 2026
Reimbursement
REIMB_002
September 1, 2024
September 1, 2024
October 1, 2027
Reimbursement
REIMB_003
September 1, 2024
July 1, 2024
October 1, 2026
Reimbursement
REIMB_004
September 1, 2024
July 11, 2024
July 11, 2026
Reimbursement
REIMB_005
September 1, 2024
July 11, 2024
July 11, 2026
Reimbursement
REIMB_006
September 1, 2024
July 12, 2024
July 12, 2026
Reimbursement
REIMB_007
September 1, 2024
July 1, 2024
July 1, 2026
Reimbursement
REIMB_008
September 1, 2024
July 15, 2024
July 15, 2026
Reimbursement
REIMB_007
September 1, 2024
June 1, 2024
October 1, 2026
Reimbursement
REIMB_010
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_011
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_012
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_013
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_014
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_015
September 1, 2024
July 17, 2024
July 17, 2026
Reimbursement
REIMB_016
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_030
September 1, 2024
September 1, 2024
September 1, 2026
Reimbursement
REIMB_031
May 1, 2025
May 1, 2025
October 1, 2026
Clinical
N/A
April 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
Pharmacy
N/A
December 1, 2024
Pharmacy
N/A
October 1, 2025
Pharmacy
N/A
December 1, 2025
Pharmacy
N/A
February 1, 2026
Pharmacy
PHARM_0063
July 1, 2025
March 9, 2026
March 9, 2027
Pharmacy
N/A
May 1, 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_099
January 1, 2026
October 13, 2025
October 13, 2026
Medical
MM_0100
January 1, 2026
February 17, 2026
February 17, 2028
Medical
MM_0101
February 17, 2026
January 5, 2026
February 17, 2028
Medical
MM_0102
January 1, 2026
February 9, 2026
February 9, 2027
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_005
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_007
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_008
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_004
September 1, 2024
March 9, 2026
March 9, 2027
Medical
MM_013
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_015
September 1, 2024
March 16, 2026
March 17, 2027
Medical
MM_016
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_017
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_018
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_019
September 1, 2024
March 16, 2026
March 16, 2027
Medical
MM_020
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_027
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_028
September 1, 2024
March 30, 2026
March 30, 2027
Medical
MM_029
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_033
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_021
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_045
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_047
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_048
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_049
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_050
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_051
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_052
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_056
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_057
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_058
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_059
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_060
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_063
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_064
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_065
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_066
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_066
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_069
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_072
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_073
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_074
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_076
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_077
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_078
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_079
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_0107
January 1, 2026
April 27, 2026
April 27, 2027
Medical
MM_055
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_083
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_084
September 1, 2024
April 27, 2026
April 27, 2027
Medical
MM_092
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