Clinical Guidelines
Resources for Providers
Medicare Guidelines – Medicare
Community Health Plan of Imperial Valley utilizes Milliman Care Guidelines (MCG) when reviewing requests. A copy of the criteria will be provided upon request to the contracted and/or non-contracted providers.
Chronic Obstructive Pulmonary Disease
Global Initiative for Chronic Obstructive Lung Disease – GOLD Report
Hypertension
American College of Cardiology Foundation/ American Heart Association – Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults
Congestive Heart Failure
American Heart Association/ American College of Cardiology Foundation/ Heart Failure Society of America – Guideline for the Management of Heart Failure
Asthma
National Heart, Lung, and Blood Institute – Guidelines for the Diagnosis and Management of Asthma
Women’s Health
Women’s Preventative Services Initiative/ U.S. Preventive Services Task Force/ Bright Futures –Recommendations for Well-Woman Care
Human Immunodeficiency Virus
American College of Obstetricians and Gynecologists – Pre-Exposure Prophylaxis for the Prevention of Human Immunodeficiency Virus
Chronic Pain
American Academy of Family Physicians/ Centers for Disease Control and Prevention – Opioid Prescribing for Chronic Pain
Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration – Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings
Transgender Care
The World Professional Association for Transgender Health – Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People
To request a free copy of the clinical guidelines used to make the decision please call us at: Call 1-888-484-1412 (TTY: 1-888-671-3263), 24 hours a day, 7 days a week. The call is free.