Change in Condition Rate Review Requests

Review Request Form

Nursing Homes

Nursing Home Bed Hold Request (electronic)

Nursing Home Bed Hold Request (paper)

Current Contract Addenda

Adult Day Care

Certified Adult Family Home

Community Based Residential Facility

Community Supported Living

Daily Living Skills Training

Day Habilitation Services

Day Services

Financial Management Services

Financial Management Services-SDS

Home Delivered Meals

Home Health Nursing Services

Home Health Care

Housing Counseling

Licensed Adult Family Home

Nursing Home

Personal Electronic Monitoring and Response Services

Pre-Vocational Services

Residential Care Apartment Complex


Self Directed Supports

Support Broker

Supported Apartment Program

Supported Employment

Supportive Home Care

Symptom Management

Translation Interpreter Services



Claims Appeal Submission Information

Clean Claims

Service Contract

LCI Service Provider Contract

LCI Encryption User Guide

Attachment 1: Rates and Service Code Chart

Attachment 2: Appeals and Grievance Policy

Attachment 3: Member Use of Personal Resources

Attachment 4: HIPAA

Attachment 5: Insurance Minimum Requirements

Restrictive Measures 

Restrictive Measures Policy and Procedure

DHS Restrictive Measures Guidelines and Standards

Member Rights and Responsibilities

Member Rights and Responsibilities Policy and Procedure

Health and Wellness

Annual Wellness Handbook

WPS Forms and Claims Information

FAMC CLTS General Claim Submission Requirements

WPS Electronic Data Services External Access Request Form

WPS Corrected Claim Form

Corrected Claim Form Tip Sheet

Family Care Claim Submission Tips

Family Care Claim Form Outline