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

Guidelines

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

ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure (2017).

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

Preterm birth

Guidelines

Acute Stress Disorder & Posttraumatic Stress Disorder

American Psychiatric Association Practice Guidelines

Alcohol

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 

Eating Disorders

American Psychiatric Association Practice Guidelines

American Psychiatric Association (APA) Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition.

Obsessive-Compulsive Disorder

American Psychiatric Association Practice Guidelines

Diagnosis and Management of Generalized Anxiety and Panic Disorder in Adults

Schizophrenia

American Psychiatric Association Practice Guidelines

Substance Use Disorders

American Psychiatric Association Practice Guidelines

Suicidal Behaviors

American Psychiatric Association Practice Guidelines