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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
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Clinical Practice Guidelines

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Clinical Practice Guidelines 
The practice guidelines included on this website are not intended to be required treatment protocols. Physicians and other health professionals must rely on their own expertise in evaluating and treating patients. Practice guidelines are not a substitute for the best professional judgment of physicians and other health professionals. Behavioral health guidelines may include commentary developed by the Company’s behavioral health committees. Further, while authoritative sources are consulted in the development of these guidelines, the practice guideline may differ in some respects from the sources cited. With respect to the issue of coverage, each patient should review his/her Policy or Certificate and Schedule of Benefits for details concerning benefits, procedures and exclusions prior to receiving treatment. The practice guidelines do not supersede the Policy or Certificate and Schedule of Benefits.  
Table of Contents  
Asthma
Behavioral Health
Chlamydia
Chronic Heart Failure (CHF)
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Artery Disease (CAD)
Diabetes
High Blood Cholesterol
Human Papillomavirus (HPV)
Hypertension (High Blood Pressure)
Maternity and Perinatal
Vascular At Risk
 
Asthma (reviewed 5/17/2012)  
National Heart, Lung, and Blood Institute

Guidelines for the Diagnosis and Management of Asthma (EPR 3 Summary Report 2007)

 
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Behavioral Health  
 
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Chlamydia (reviewed 2/12, approved 3/12)  
Centers for Disease Control and Prevention (CDC)

http://www.cdc.gov/std/treatment/2010

 
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Chronic Heart Failure (CHF) (in the Adult) (reviewed 5/17/2012)  
American Heart Association/American College of Cardiology

2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

 
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Chronic Obstructive Pulmonary Disease (COPD) (reviewed/approved 2/13)  

Global Initiative for Chronic Obstructive Lung Disease (GOLD.)

 
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Coronary Artery Disease (CAD) (Reviewed and Approved 9/1/2012)
Circulation –AHA/ACCF Guideline
 
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Diabetes (reviewed/approved 2/13)  
American Diabetes Association
2013 Standards of Care
 
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High Blood Cholesterol (reviewed 9/11)  
National Institutes of Health (NIH)

Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

 
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Human Papillomavirus (HPV) (reviewed 2/12)  
Centers for Disease Control and Prevention (CDC)

Sexually Transmitted Diseases – Treatment guidelines 2010 (Human Papillomavirus Infections)

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Hypertension (High Blood Pressure) (reviewed 9/11)  
National Heart, Lung, and Blood Institute

High Blood Pressure Guidelines (JNC 7)

 
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Maternity & Perinatal (reviewed/approved 2/13) 
Guidelines for Perinatal Care, 7th edition, 2012, American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG)  

Summary of Perinatal Care Guidelines

 
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Vascular At Risk (Reviewed and Approved 9/1/2012) 
Vascular At Risk – Hypertension
Vascular At Risk – Hyperlididemia
 
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Last Update: 03/15/13  
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