Skip to main content
Focus on life. Focus on health. Stay focused.

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.

Access to Care Standards

Access to Care Standards form.

Asthma in Pregnancy

2008 ACOG Guideline for treating asthma during pregnancy.

 

Chart Tools

Pediatric Initial History

Adult Initial History

Diagnostic Summary

Diabetes Flow Sheet

2 Week Well Check

2 Month Well Check

4 Month Well Check

6 Month Well Check

9 Month Well Check

12 Month Well Check

15 Month Well Check

18 Month Well Check

24 Month Well Check

Boys' BMI Chart

Girls' BMI Chart

Growth Charts

Chlamydia Sexual Health Questionnaire

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:

In-Office and STAT Lab List

Kidney Disease

Access kidney count resources, including KDOQI guidelines, a 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 (800) 868-1032. Members or their physicians may call to obtain a referral.

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 the S.C. 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 Web site 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 Pain

American 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 Disorder
 

American 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 Kit

 

Cancer (Supportive Care in Oncology)

National Comprehensive Cancer Network (NCCN)
National Comprehensive Cancer Network Clinical Practice Guidelines 


Chlamydia
Centers for Disease Control and Prevention (CDC)
Sexually Transmitted Diseases - Treatment Guidelines 2006 (Chlamydial Infections) 


Chronic Kidney Disease

National 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 Disease

 

Congestive Heart Failure (CHF)

American College of Cardiology Foundation/American Heart Association

2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure

 

Coronary Artery Disease (CAD)

American College of Cardiology Foundation & American Heart Association

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults(2013)  

2012 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Unstable Angina/Non – ST-Elevation Myocardial Infarction (Updating the 2007 Guideline and Replacing the 2011 Focused Update) (2012)

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/American College of Cardiology

AHA/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 Cholesterol

American College of Cardiology/American Heart Association

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)
 

Human Papillomavirus (HPV)
Centers for Disease Control and Prevention (CDC)
HPV Information for Clinicians - Brochure on transmission, prevention, detection and clinical management of HPV (April 2007)


Hypertension (High Blood Pressure)

American College of Cardiology/American Heart Association

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 

Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention (2007)


Immunization Guidelines

Center for Disease Control and Prevention

Immunization Schedules

 

Maternity/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/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: Children
Endocrine Society

Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

 

Office 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 Cessation

 

Preventive 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 & Immunizations Information

 

Preterm Labor Assessment Toolkit

This toolkit provides guidance for the assessment and triage of women with suspected preterm labor.

Postnatal Depression Scale

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:

  1. Diet, nutrition and exercise
  2. Postpartum mental health
  3. Sexuality and contraception
Radiology Policies

View the National Imaging Associates Radiology Policies. You will need to select "BlueChoice HealthPlan" and then the study desired.

Vaccines and Immunizations

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.