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

American Academy of Pediatrics (AAP): ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, October 2019

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

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 Initiative for Chronic Obstructive Lung Disease 2019 Report

Centers for Disease Control and Prevention

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

Diabetes

ADA’s current clinical practice recommendations

2020 American Diabetes Association (ADA) Standards of Medical Care in Diabetes

Clinical Care Guidelines and Resources

Guidelines Made Simple|2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults

Immunizations

CDC Guideline

CDC 2020 Immunization Schedules

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians

Preterm birth

Major Depressive Disorder

APA Guidelines

Management of Major Depressive Disorder (MDD) (2016)

Opiods for Chronic Pain

CDC Guideline

CDC Guideline for Prescribing Opioids for Chronic Pain-United States,2016

U.S. Preventive Services Task Force (USPSTF)

Cessation Material for State Tobacco Control Programs

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