Provider Policies and Standards

Corporate Medical Policies

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

Corporate Reimbursement Policies

Medical Mutual has certain policies that offer guidance for payment determinations for a service or guidance for the way a service should be billed to Medical Mutual.

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Prescription Drug Resources

Learn more about our prescription drug programs, download our drug formulary lists and more.

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Accessibility Standards

Accessibility standards help ensure our members receive timely and safe care.

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Clinical Practice Guidelines

Evidence-based guidelines for treating patients with specific health issues.

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Medical Drug Management

Learn more about our medical drug management program and how it's used to manage specialty drugs.

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Medical Necessity Criteria and Clinical Review Guidelines

View our guidelines for evaluating whether a service is medically necessary.

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Prior Approval and Investigational Services

Learn more about our prior approval and investigational service processes.

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