To help provide our members with consistent, high-quality care that uses services and resources effectively, we have chosen certain clinical guidelines to help our providers. These include treatment protocols for specific conditions, as well as preventive health measures.
These guidelines are intended to clarify standards and expectations. They should not:
- Take precedence over your responsibility to provide treatment based on the member’s individual needs
- Substitute as orders for treatment of a member
- Guarantee coverage or payment for the type or level of care proposed or provided
Clinical policy bulletins
Clinical practice guidelines - Medical
National Heart, Lung and Blood Institute (NHLBI) - Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full report (2007).
Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (2017).
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2018).
Centers for Disease Control and Prevention
Coronary Artery Disease
- American Diabetes Association (ADA) Standards of Medical Care in Diabetes (2018).
- Diabetes Summary of Revisions
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure (2017).
Clinical Decision Support Tool
Primary Care Guidelines for the Management of Persons Infected With HIV. Update by the HIV Medicine Association of the Infectious Diseases Society of America (2013).
American College of Cardiology, Guidelines Made Simple (2017)
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians
Clinical practice guidelines - Behavioral Health
Acute Stress Disorder & Posttraumatic Stress Disorder
Attention Deficit/Hyperactivity Disorder in Children and Adolescents
National Institute on Alcohol Abuse and Alcoholism (NIAAA), Helping Patients Who Drink Too Much, A Clinician’s Guide, 2005 Edition
Children and Families in the Aftermath of Disasters and Crises
American Academy of Pediatrics (AAP) - Providing Psychosocial Support
Disruptive Behavior Disorders in Children and Adolescents
Agency for Healthcare Research and Quality - Psychosocial and Pharmacologic Intervention
American Psychiatric Association (APA) Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition.
Diagnosis and Management of Generalized Anxiety and Panic Disorder in Adults
Substance Use Disorders
Preventive health guidelines
- U.S. Preventive Services Task Force A and B recommendations
- Advisory Committee for Immunization Practice (ACIP) Vaccine Recommendation
- American Academy of Pediatrics Periodicity Schedule
- Domestic violence screening and domestic violence screening tool
- Hepatitis C screening
- HIV screening
- CDC vaccine recommendations for pregnant women
- Vaccines for Pregnant Women
Medications for Prevention of Preterm Births