Clinical Resources
Here you can find information on practice guidelines, radiology policies and experimental procedures. You can also download valuable chart tools such as well-child checkup sheets, initial history forms and diagnostic summaries.
Many of these resources are provided by independent organizations that provide health information you may find helpful. Many links on this page lead to third-party websites. Those parties are solely responsible for the contents and privacy policies of their sites.
- Access to Care Standards
- Asthma in Pregnancy
-
2008 American College of Obstetricians and Gynecologists (ACOG) Guideline for treating asthma during pregnancy
- Chart Tools
- Chlamydia Sexual Health Questionnaire
- Depression and Coronary Heart Disease
-
Access the American Heart Association Science Advisory, "Depression and Coronary Heart Disease: Recommendations for Screening, Referral and Treatment."
- In-Office and Stat Lab List
-
This is a list of labs appropriate for in-office and STAT requests:
- Kidney Disease
-
Access kidney count resources, including kidney disease outcomes quality initiatives (KDOQI) guidelines, a glomerular filtration rate (GFR) calculator and patient education information at the National Kidney Foundation site.
- Mental Health and Substance Abuse Information
-
Companion Benefit Alternatives (CBA) manages the mental health and substance abuse benefits for most of our members and their dependents. CBA is a separate company that manages behavioral health benefits on behalf of BlueChoice HealthPlan. (Please note: Employers may choose another organization to manage these benefits, so please check with your patients to see what coverage they have.) CBA offers confidential guidance in getting referrals to outpatient professionals for diagnosis and treatment of sensitive behavioral health problems, including:
- Depression
- Anxiety
- Substance Abuse
- Eating Disorders
- And more
CBA has more than a decade's experience in clinical and behavioral health benefits management. The staff includes board-certified psychiatrists, registered psychiatric nurses, licensed practical nurses, social workers and professional counselors, with a wide variety of clinical backgrounds.
How Can CBA Help?
CBA can help make referrals to a health care professional that's in the network. This means your patient will enjoy a higher level of coverage than if he or she went to someone outside the network. The network has professionals within the state of South Carolina and across the country. It features board-certified psychiatrists and addictionologists. It also has licensed psychologists, social workers and professional counselors. All these health care professionals will file claims and get pre-certifications from CBA for your patients.CBA requires network professionals to follow the credentialing standards from the National Committee of Quality Assurance (NCQA). This independent, not-for-profit organization is dedicated to assessing and reporting on the quality of managed care plans.
If the member's employer has contracted for an employee assistance program (EAP), CBA will try to coordinate with that program for ongoing treatment for a behavioral health problem.
If you have questions or would like to make a referral, please call
. Members or their physicians may call to obtain a referral.(800) 868-1032
- Mental Health Parity Law
-
In 2005, South Carolina passed a mental health parity law. We are using our experience with that law to approach the new federal parity law. In addition to the mental health benefits required by South Carolina law, we are adding coverage for substance use disorders and additional clinical disorders.
The new federal mental health parity law makes strong utilization management of mental health and substance use benefits more important than ever. We have the experience to help you navigate this new terrain.
- Practice Guidelines
-
We are committed to supporting our providers in the care of our members by making clinical best practice references available.
Clinical Practice Guidelines
We have adopted the recommendations of the following organizations as our practice guidelines. With permission from these organizations, BlueChoice HealthPlan has created direct links from our website to these guidelines.
BlueChoice HealthPlan's Quality Medical Advisory Panel (QMAP) reviews and adopts all guidelines at least annually and more frequently if necessary to review new scientific evidence or national standards as they are published.
While we review the guidelines annually, you should not construe them as a legal or required standard of care, or as an indication they will always apply in every medical situation. These are recommendations only, and do not guarantee any medical results or indicate coverage for such services by any given plan or policy.
We hope these guidelines will be a convenient resource in helping you care for your patients.
Asthma
National Institutes of Health: National Heart, Lung and Blood Institute
Guidelines for the Diagnosis and Management of Asthma (EPR-3 Report 2007) (2007)
NHLBI Guidelines Asthma Care Quick Reference Guide (2012)
Back PainAmerican College of Physicians
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians (2017)
Behavioral Health
Attention Deficit Hyperactivity DisorderAmerican Academy of Pediatrics (AAP)
Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2011)Clinical Practice Guideline: Diagnosis and Evaluation of the Child with Attention-Deficit/Hyperactivity Disorder (PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1158-1170)
Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder (PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1033-1044)
Bright Futures at Georgetown
Bright Futures in Practice: Mental Health — Volume II, Tool KitCancer (Supportive Care in Oncology)
National Comprehensive Cancer Network (NCCN)
National Comprehensive Cancer Network Clinical Practice Guidelines
Chronic Kidney DiseaseNational Kidney Foundation (NKF)
Kidney Disease Quality Outcomes Initiative (KDQOI) Clinical Practice Guidelines
Chronic Obstructive Pulmonary Disease (COPD)Global Initiative for Chronic Obstructive Pulmonary Disease
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary DiseaseCongestive Heart Failure (CHF)
American College of Cardiology Foundation/American Heart Association
Coronary Artery Disease (CAD)
American College of Cardiology Foundation & American Heart Association
2013 ACC and AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults(2013)American Heart Association
Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women — 2011 Update: A Guideline from the American Heart Association (2011)American Heart Association (AHA) and American College of Cardiology Foundation (ACCF)
AHA and ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline from the American Heart Association and the American College of Cardiology Foundation (2011)Depression
US Preventive Services Task Force
Screening for Depression in Adults (2016)American Psychiatric Association
Practice Guideline for the Treatment of Patients with Major Depressive Disorder (2010)Treating Major Depressive Disorder: A Quick Reference Guide (2010)
Diabetes
American Diabetes Association (ADA)
Standards of Medical Care in Diabetes (2018)
High Blood CholesterolAmerican College of Cardiology (ACC) and American Heart Association (AHA)
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults(2013)
National Institutes of Health: National Heart, Lung and Blood Institute
Third Report of the Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) (updated 2004)
Hypertension (High Blood Pressure)
American College of Cardiology (ACC) and American Heart Association (AHA)
2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults (2017)National Institutes of Health: National Heart, Lung and Blood Institute
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) (2014)American Heart Association
Immunization GuidelinesCenter for Disease Control and Prevention
Immunization SchedulesMaternity/Perinatal Guidelines
US Preventive Services Task Force
Screening for Depression in Adults (2016)American Congress of Obstetricians and Gynecologists
Guidelines for Perinatal Care, Seventh Edition (2012)Metabolic Syndrome
American Heart Association (AHA) and National Heart, Lung and Blood Institute
Diagnosis and Management of the Metabolic Syndrome (2005)Migraine
American Academy of Neurology
Clinical Practice Guidelines
Practice Parameter: Evidence-Based Guidelines for Migraine Headache (2000)International Headache Society
International Classification of Headache Disorders, Third Edition (ICHD-3) (2013)Obesity and Overweight: Adults
Office of Disease Prevention and Health Promotion
2015 – 2020 Dietary Guidelines for Americans (2016)American Heart Association/American College of Cardiology
Guideline for the Management of Overweight and Obesity in Adults (2013)National Institutes of Health: National Heart, Lung, and Blood Institute
The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults (2000)
Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults (1998)
Obesity and Overweight: ChildrenEndocrine Society
Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice GuidelineOffice of Disease Prevention and Health Promotion
2015 – 2020 Dietary Guidelines for Americans (2016)National Institutes of Health: National Heart, Lung and Blood Institute
Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk and Reduction in Children and Adolescents (Summary Report) (2012)
Physical Activity Guidelines
U.S. Department of Health and Human Services
2008 Physical Activity Guidelines for Americans (2008)
Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth (2012)Prediabetes
American Diabetes Association
Standards of Medical Care in Diabetes (2018)Preventive Guidelines
U.S Preventive Services Task Force (USPSTF)
The Guide to Clinical Preventive Services (2014)
USPSTF A – Z Topic Guide (2013)American Academy of Family Physicians
Summary of Recommendations for Clinical Preventive Services (2017)Tobacco Cessation Guidelines
Agency for Healthcare Research and Quality (AHRQ)
Clinical Guidelines for Prescribing Pharmacotherapy for Smoking CessationPreventive Health Guidelines
We have adopted the recommendations of the U.S. Department of Health and Human Services through the Public Health Service, the Office of Public Health and Science, and the Office of Disease Prevention and Health Promotion as our preventive health guidelines for adults, children and adolescents. With permission from these organizations, BlueChoice HealthPlan has created direct links from our Web site to these guidelines.
While we review the guidelines annually, you should not construe them as a legal or required standard of care, or as an indication they will always apply in every medical situation. These are recommendations only, and do not guarantee any medical results or indicate coverage for such services by any given plan or policy.
We hope these guidelines will be a convenient resource in helping you care for your patients.
Preventive Health Guidelines for Children and Adolescents
Centers for Disease Control and Prevention, Vaccines and Immunizations Information
- Preterm Labor Assessment Toolkit
-
This toolkit provides guidance for the assessment and triage of women with suspected preterm labor.
- Postnatal Depression Scale
- Postpartum Counseling Guide
-
This Quick Reference Guide for Clinicians is designed to assist health care providers in counseling women in the postpartum period. It addresses three important areas of concern to these patients:
- Diet, nutrition and exercise
- Postpartum mental health
- Sexuality and contraception
- Radiology Policies
-
View the National Imaging Associates Radiology Policies.* You will need to select "BlueChoice HealthPlan" and then the study desired.
*RadMD is an online tool offered by Magellan Healthcare that allows contracting health care providers to enter authorization requests via the internet. Magellan Healthcare is an independent company that provides utilization management services of certain radiology procedures on behalf of BlueChoice HealthPlan.
- Vaccines and Immunizations
-
The Epidemiology and Prevention of Vaccine-Preventable Diseases, 11th Edition. The Pink Book is published by the National Immunization Program, Centers for Disease Control and Prevention. The Pink Book provides physicians, nurses, nurse practitioners, physician assistants, pharmacists, and others with the most comprehensive information on vaccine-preventable diseases.