Policies & Procedures

Access to Care — CC05
Policies & Procedures — Quality
Last Updated: 05/02/2024

Access to Women’s Health Care Services — CC04
Policies & Procedures — Care Coordination
Last Updated: 03/06/2025

Credentialing Plan — CR01
Policies & Procedures — Credentialing
This document gives providers the requirements to become and remain a PrimeWest Health network provider.
Last Updated: 07/01/2025

Credentialing: Practitioner Rights — CR16
Policies & Procedures — Credentialing
This document provides our practitioners with their rights to review their credentialing documents.
Last Updated: 03/06/2026

Health Records Policy and Procedure — QM06
Policies & Procedures — Health Record Reviews/Site Visits
This policy and procedure documents how PrimeWest Health maintains standards and guidelines for documenting and managing members' health and mental health records.
Last Updated: 05/21/2026

Mental Health Targeted Case Management – CC23
Policies & Procedures – Behavioral Health
This policy documents how PrimeWest Health provides case management services to the extent authorized by the State agency to people with Serious and Persistent Mental Illness (SPMI) and children with Service Emotional Disturbances (SED).
Last Updated: 05/01/2025

Provider Appeal – PS01
Policies & Procedures — Provider Network Administration
This policy documents how PrimeWest Health provides a fair and reasonable process whereby providers may Appeal PrimeWest Health’s claims adjudication decisions and ensures that provider Appeals are properly investigated and resolved within 30 days of receipt of all necessary and pertinent documentation for both participating and non-participating providers.
Last Updated: 06/05/2025

Provider Office Site Visits — QM05
Policies & Procedures — Health Record Reviews/Site Visits
This policy and procedure documents office site standards and guidelines for primary care, specialty care, and mental health clinics and how PrimeWest Health maintains these standards and guidelines for provider office sites.
Last Updated: 05/13/2026

Quality Assurance Plan — QM03
Policies & Procedures — Quality
This Policy & Procedure presents the written Quality Assurance Plan and describes the PrimeWest Health Quality Program.
Last Updated: 03/06/2025

Technologies, New & Existing — UM11
Policies & Procedures — Utilization Management
Last Updated: 03/06/2025

Utilization Management Plan — UM01
Policies & Procedures — Utilization Management
This Policy & Procedure outlines the comprehensive, systematic approach to the delivery of effective and appropriate care and services to members.
Last Updated: 03/06/2025

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