Clinical Practice Guidelines for Commercial and Medicare plans
Clinical Practice Guidelines are based on established evidence-based standards of care from specialty societies and national clinical organizations. The guidelines inform our quality and health management programs. They’re also the foundation for select condition management programs and support decision-making in patient care.
Our Clinical Quality Committee reviews and updates the guidelines at least every two years and when new significant findings or major advancements in evidence-based practices and standards of care are established.
The guidelines aren’t intended to substitute for clinical judgment in individual cases. Providers are encouraged to make decisions based on their own judgment and the most current evidence-based information available.
Recommendations from national entities may vary. At this time, we endorse the American Academy of Family Physicians and American College of Physicians criteria for defining high blood pressure.
If you have questions about the guidelines or want to provide feedback, contact the Quality Improvement Department at 312-653-3465.
Following are our current guidelines:
- Asthma Management and Prevention
- Cardiovascular Disease Guideline
- Chronic Kidney Disease Guidelines
- COPD Diagnosis Management and Prevention
- Diabetes Standards of Care
- Heart Failure Guidelines
- Hepatitis C Guidelines
- Hypertension Guidelines
- Metabolic Syndrome Guideline
- Sleep Apnea Guidelines
- Tobacco Cessation Guideline
- Weight Management
Human Immunodeficiency Virus guidelines
Clinical Practice Guidelines for Illinois Medicaid Plans
The Clinical Practice Guidelines for Illinois Medicaid plans are adopted by BCBSIL through the Quality Assurance Committee. These guidelines are based on established evidence-based best practice standards of care, publicized by leading academic and national clinical organizations. BCBSIL uses evidence-based clinical guidelines from nationally recognized sources to guide our quality and health management programs. Guidelines are designed to support the decision-making processes in patient care. Recommendations from other national entities may vary.
These guidelines are updated annually and when new significant findings or major advancements in evidence-based best practices and standards of care are established. If you have questions about the guidelines, or wish to provide feedback on the guidelines, email the Illinois Medical Quality Improvement Department.
The Clinical Practice Guidelines (CPG’s) are meant to serve as general guidelines and are not intended to substitute for clinical judgment in individual cases. At this time, BCBSIL endorses the AAFP and ACP criteria for defining high blood pressure, which varies from the values provided in other guidelines. Providers are encouraged to make decisions based on their own judgement and most current evidence-based information available. The links below provide information about the CPGs:
- Asthma 2022 Guidelines for Diagnosis and Management
- Behavioral Health Clinical Practice Guidelines
- Cardiovascular Disease Guideline
- Chronic Kidney Disease
- Community Reintegration and Support
- Coordination of Community Support and Services for Enrollees in HCBS Waivers and Long-term Care (LTC) Residential Coordination of Services
- COPD Diagnosis, Management and Prevention
- Dental Services
- Diabetes 2023 Standards of Care
- Family Planning
- Heart Failure Guidelines
- HIV Clinical Practice Guidelines
- Comprehensive Human Immunodeficiency Virus
- Hypertension Guidelines
- Infertility
- Management of Overweight and Obesity in Adults
- Metabolic Syndrome Guideline
- Preconception
- Reproductive Health
- Tobacco Cessation Guideline