Forms and Materials
Forms and Materials
Nursing Homes
Nursing Home Bed Hold Request (electronic)
Nursing Home Bed Hold Request (paper)
Instructions For Member HIPPS Notification Form
Member HIPPS Notification Form
Current Contract Addenda
Community Based Residential Facility
Community Supported Living (CSL)
Personal Emergency Response System and Electronic Monitoring
Residential Care Apartment Complex
Translation-Interpreter Services
Claims
Claims Appeal Submission Information
Provider Portal
Service Contract
Attachment 1: Rates and Service Code Chart
Attachment 2: Appeals and Grievance Policy
Attachment 3: Member Use of Personal Resources
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
WPS Forms and Claims Information
FAMC CLTS General Claim Submission Requirements
WPS Electronic Data Services External Access Request Form
Corrected Claim Form Tip Sheet