PA Resources Portlet

Resources

CODING & DOCUMENTATION

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

HEALTHCARE INFORMATION & TECHNOLOGY

PATIENT HEALTH

PHARMACY

POLICIES & GUIDELINES

Advanced Imaging

Autism Spectrum Mandate

Behavioral Health

Blue Advantage Policies

Chronic Condition Management

Clinical Practice Guidelines

COVID-19

HealthSmartRx Smart RxAssist

Hemophilia Drug Management

Medical Nutrition Therapy Services

Medical Policies

Medical Records Requests

No Surprise Billing Act

Operational Guidelines

Provider Appeals

Provider Disputes

Provider-Administered Drug Policies

Radiation Therapy Management (RTM)

Self-Administered Drug Policies

Subrogation

Telehealth and Remote Access Telemedicine

Transgender Services

PRE-SERVICE REVIEW

PROGRAMS & INITIATIVES

PROVIDER NETWORKS & SPECIALTIES

PA Dynamic Rendering

Clinical Practice Guidelines

Practice and Preventive Health Guidelines

All Blue Cross and Blue Shield of Alabama guidelines are based on the most current scientific evidence, and are adapted from standards published by nationally recognized authorities. In addition, each guideline is reviewed and approved at least annually by the Blue Cross Quality of Care Committee.

Click on the links below to view the guidelines.

Preventive Health Guidelines

Preventive Health Guidelines are standards of care developed to encourage the appropriate provision of preventive services to patients, according to their age, gender and risk-status. These services include screenings, immunizations and physical examinations.

Perinatal Care

Guidelines for Perinatal Care, 7th edition, 2012
Source: American College of Obstetricians and Gynecologists, American Academy of Pediatrics

0-21 Years

Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, 4th Edition, 2017
Source: American Academy of Pediatrics

The Bright Futures/American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care, 2017
Source: American Academy of Pediatrics

20-64 Years

Summary of Recommendations for Clinical Preventive Services, January 2017
Source: United States Preventive Services Task Force (USPSTF); American Academy of Family Physicians

65+ Years

Summary of Recommendations for Clinical Preventive Services, January 2017
Source: United States Preventive Services Task Force (USPSTF); American Academy of Family Physicians

Birth to 18 years - Immunizations

Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger

Source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices, January 2017

Adults 19 years and older - Immunizations

Recommended Immunization Schedule for Adults Aged 19 Years or Older
Source: Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices, February 2017

Practice Guidelines

Practice Guidelines are systematically developed statements that help practitioners make decisions about appropriate healthcare for specific chronic or acute clinical circumstances.

Diabetes Management

Standards of Medical Care in Diabetes 2017
Source: American Diabetes Association

Diabetes Self-Management Education and Support for Adults with Type 2 Diabetes: Algorithm of Care

Sources: American Diabetes Association, American Association of Diabetes Educators, Academy of Nutrition and Dietetics

Diabetes Self-Management Education and Support for Adults with Type 2 Diabetes: Algorithm Action Steps

Sources: American Diabetes Association, American Association of Diabetes Educators, Academy of Nutrition and Dietetics

Guidelines for Coverage of Diabetes  Self-Management Education (DSME) Programs

Cardiovascular Disease Management

My American Heart: Statements and Guidelines
Source: American Heart Association, American Stroke Association and American College of Cardiology

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults
Source: American Medical Association

Guidelines of Primary Prevention of Stroke, 2014
Source: American Heart Association and American Stroke Association

Aspirin for Primary Prevention of Cardiovascular Events in People with Diabetes, 2010
Source: American Diabetic Association, American Heart Association, and American College of Cardiology Foundation

Attention Deficit/Hyperactivity Disorder Child and Adolescent

Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline, 2016

Source: American Academy of Pediatrics

ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, 2011
Source: American Academy of Pediatrics

ADHD Child and Adolescent Clinical Guideline
Source: American Academy of Child and Adolescent Psychiatry (AACAP) and collaboration with Lucet

Adult Major Depression Guideline for Initial Outpatient Treatment of Adults

Major Depression Guideline for Initial Outpatient Treatment of Adults, 2015
Source: American Psychiatric Association and collaboration with Lucet

Opioid Prescription Management

CDC Guideline for Prescribing Opioids for Chronic Pain, 2016
Source: Centers for Disease Control and Prevention

The information provided within these guidelines is general information and not a guarantee of payment. Benefits are always dependent on whether the service is medically necessary and within the terms of a Blue Cross and Blue Shield of Alabama Member's Benefit Agreement and Blue Cross and Blue Shield of Alabama policies.