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
National Heart, Lung and Blood Institute (NHLBI) - Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (2012)
Attention - Deficit/Hyperactivity Disorder
American Academy of Pediatrics (AAP): Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in Children and Adolescents (2019).
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) (2019).
Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (2016)
Coronary Artery Disease
Congestive Heart Failure
Major Depression Disorder
Preventive health guidelines
- U. S. Preventive Services Task Force (USPSTF)
- Centers for Disease Control and Prevention (CDC)- Immunizations Schedules
- Maryland Healthy Kids/EPSDT