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

Translation Interpreter Services

Adult Day Care

Supportive Home Care

Supported Apartment Program

Home Health Care


Pre-Vocational Services

Daily Living Skills Training

Personal Electronic Monitoring and Response Services

Certified Adult Family Home

Licensed Adult Family Home

Home Delivered Meals

Nursing Home

Symptom Management

Supported Employment

Financial Management Services

Financial Management Services-SDS

Day Services

Residential Care Apartment Complex


Housing Counseling

Community Supported Living

Community Based Residential Facility


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