November 2020

Clinical Practice and Preventive Care Guidelines Updated for 2020-2021

Our medical directors and Quality Improvement Committee have updated our Clinical Practice Guidelines and Preventive Care Guidelines for the 2020-2021 year. The guidelines are built on evidence-based standards of care and nationally recognized medical authorities to direct our quality and health management programs and improve member care. They may help guide your decision-making as you care for our members.

We update our guidelines at least every two years or when new significant findings or major advancements in evidence-based care are established. The guidelines are on our website under Clinical Resources.

If you have any questions about the guidelines, or wish to provide feedback on commercial guidelines, contact our Quality Improvement Department at 312-653-3465, or on Medicaid guidelines, email the Illinois Medicaid Quality Improvement Department.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.