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Medical Policy and Clinical UM Guidelines

View our medical policies and clinical UM guidelines

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Clinical Practice Guidelines

Clinical Practice Guidelines  
You can locate each of the Clinical Practice Guidelines (CPGs) listed by accessing the links provided. The CPGs are based upon guidelines developed by nationally recognized sources such as the American Diabetes Association, American Congress of Obstetricians and Gynecologists, National Heart Lung and Blood Institute, and others. These organizations produce evidence-based guidelines using medical literature, professional standards, and/or expert opinions. CPGs are not a substitute for the professional judgment of physicians or other health professionals. Further, while authoritative sources are consulted in the development of these guidelines, the practice guideline may differ in some respects from the sources cited. CPGs are made available to network providers for all lines of business (unless otherwise noted), through committee meetings, provider websites, newsletters and other communications as informational resources for providers and members, to assist in evidence based clinical practice, setting member goals for health improvement, and other clinical purposes. CPGs are not used by the plan for medical necessity review. The health plan develops Medical Policies and UM Guidelines (Medical Policies) for this purpose. The practice guidelines do not supersede the member’s health benefit plan or Certificate and Schedule of Benefits. With respect to the issue of coverage, each member should review his/her health benefit plan or Certificate and Schedule of Benefits for details concerning benefits, procedures and exclusions prior to receiving treatment.  
Last Update: 1/25/2018  
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