Guidelines

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

 

Asthma

National Heart, Lung and Blood Institute (NHLBI) - Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full report (2007)

Asthma Care Quick Reference (2012)

Alcohol Use

National Institute on Alcohol Abuse and Alcoholism (NIAAA), Helping Patients Who Drink Too Much, A Clinician's Guide, 2005 Edition

 

Acute Stress Disorder & Posttraumatic Stress Disorder
American Psychiatric Association Practice Guidelines

Attention - Deficit/Hyperactivity Disorder
American Academy of Pediatrics (AAP): Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents (2011).

Bipolar Disorder
American Psychiatric Association Practice Guidelines

Chronic Kidney Disease
Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Chronic Obstructive Pulmonary Disease
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2017).

Chronic Pain

Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (2016)

Errata

Coronary Artery Disease 

AHA/ACC/HHS Strategies to Enhance Application of Clinical Practice Guidelines in Patients with Cardiovascular Disease and Comorbid Conditions

2014 Focused Update of the Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease 

Coronary Artery Disease 

2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

2013 ACCF/AHA – Heart Failure Guideline

Hypertension (HTN) 2017 Update

American College of Cardiology

Crohns
Management of Crohn's Disease in Adults, Gary R. Lichtenstein MD, Stephen B. Hanauer MD, William J Sandborn MD and The Practice Parameters Committee of the American College of Gastroenterology.

Diabetes

American Diabetes Association (ADA): Standards of Medical Care in Diabetes (2018)

American Diabetes Association: Standards of Medical Care in Diabetes - 2019 Supplement 1 

HIV/AIDS 

Tobacco Cessation 

Recommendation Immunization Schedule

Recommended Immunization Schedule 19 and older

Eating Disorder
American Psychiatric Association Practice Guidelines