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Clinical Practice Guidelines

Clinical Practice Guidelines (CPGs) and Preventive Care Guidelines  are adopted by BCBSIL and are the foundation for selected Condition Management Programs. The guidelines are updated at least every 2 years. Below is a listing of disease-specific and care management clinical practice guidelines, which include recommendations intended to optimize patient care. The guidelines are not intended to replace the clinical judgment of a physician or the needs of the individual patient.

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. 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 any questions about the guidelines, or wish to provide feedback on the guidelines, this can be done by contacting the Quality Improvement Department at 312-653-6674. 

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. The links below provide information about the CPGs: