Updated Clinical Policies - Effective July 1, 2025
Date: 05/28/25
MHS Health Wisconsin regularly adds new or provides updates to clinical and payment policies to ensure they are designed to comply with industry standards while delivering the best experiences and outcomes for our members.
The following new policies or policy revisions are effective July 1, 2025.
You can view the details of these policies on their effective date by visiting Clinical and Payment Policies.
Policy Number | Policy Name | Policy Description | Product Line(s) |
CP.MP.247 | Transplant Service Documentation Requirements | Added requirements for post-transplant follow up visits and note in the same section regarding other requests. | Medicaid; Medicare |
CP.MP.185 | Skin and Soft Tissue Substitutes for Chronic Wounds | Annual review. Removed note under description to refer to MC.CP.MP.185 for Medicare plans. Updated and replaced previous criteria I.A. through I. with new criteria I.A. through G. Also updated and replaced previous criteria II.A. through C. with new criteria I.A. through G. Description and Background reviewed and updated. Coding updated to reflect addition of preferred product list in criteria I.E. References reviewed and updated. Reviewed by an external specialist. | Medicaid; Medicare |
HIM.CP.BH.500 | Behavioral Health Treatment Documentation Requirements | Annual review. Description and background updated with no impact to criteria. Criteria statements reorganized for clarity. Updated policy statement I. to reflect “all” behavioral health treatment records…and all of the following elements, “as applicable.” Reworded criteria in I.E., and I.F. for clarity. Added criteria I.I. “Each service encounter…” and criteria I.J. “Results of required screenings….” Moved previous criteria I.N. “Plan for ongoing treatment…” under Treatment plan in I.L.1. Added Discharge summary criteria in I.Q.1-4. References reviewed and updated. | Medicaid; Medicare |
View all Clinical and Payment Policies.
Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the policies listed above or any our Clinical & Payment Policies, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who is your representative, please email us at WI_Provider_Relations@mhswi.com.