Practice Guidelines

We applaud the role you play in our members' health. To support your efforts and continuously improve the satisfaction of our members, we have adopted national practice parameters for disease management. Our goal in adopting national parameters is to help our members attain optimal quality of life. The parameters are provided to physicians for use as guidelines to assist them in clinical decision-making, and are not intended to be rigid standards.

• Asthma Practice Guidelines - Institute for Clinical Systems Improvement (PDF)
• Attention Deficit Hyperactivity Disorder - American Academy of Child and Adolescent Psychiatry
• Bipolar Disorder Practice Guidelines - National Institute of Mental Health
• Chronic Obstructive Pulmonary Disease Practice Guideline - The Global Initiative for Chronic Obstructive Lung Disease
• Diabetes Practice Guidelines - American Diabetes Association
• Heart Failure/Coronary Heart Disease Practice Guidelines - The American College of Cardiology
• Hypertension Practice Guidelines- American College of Cardiology/American Heart Association
• Major Depression Practice Guidelines - American Psychiatric Association

Preventive Services Guidelines

Preventive services include a broad range of services (including screening tests, counseling, immunizations/vaccines). We have adopted the U.S. Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services (childhood and adolescent immunization schedule approved by: the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP), adult immunization schedule approved by: the Advisory Committee on Immunization Practices (ACIP), the American College of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP).

Immunization Schedules (Childhood, Adolescent and Adult)

• Visit the Centers for Disease Control and Prevention (CDC) for recommended vaccines and immunizations.
• Visit the Guide to Clinical Preventive Services for recommendations made by the USPSTF for clinical preventive services.

Please have your patient refer to his or her contract, Evidence of Coverage, member handbook, certification of coverage, or any endorsement or rider, if applicable, to determine coverage. If your patient is unsure about particular coverage/benefits or has questions, please have the member call the Customer Service number on his or her ID card.