Provider Guidelines

Provider Guidelines

Preventive Guidelines

It is widely known that providing primary prevention services, such as childhood immunizations, can reduce the incidence of illness, disease and accidents. Secondary prevention services, such as early detection of potentially serious illnesses, may reduce the impact of the illness on the patient, thereby decreasing the cost of care. Each primary care office visit should be viewed as the only opportunity for a comprehensive assessment of the member’s health status.

We encourage providers delivering well-child care to CHRISTUS Health Plan members to use the American Academy of Pediatrics (AAP) Preventive Health Guidelines and United States Task Force Preventive Services.

Clinical Practice Guidelines

Clinical practice guidelines summarize evidence-based management and treatment options for specific diseases or conditions.

Practice guidelines are developed nationally and adopted locally through Provider Advisory Committees that include practicing physicians who participate in the plan. This group also suggests topics for guideline development, based on relevance to enrolled membership, with high-volume, high-risk, problem-prone conditions as the first priority.

CHRISTUS Health Plan programs have adopted the following guidelines:

Asthma: National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma. Read full text and a summary of the guidelines, along with supporting material and tools.

Diabetes: Refer to the current edition of the American Diabetes Association (ADA) Standards of Medical Care for Patients with Diabetes Mellitus.

Treatment of Patients With Major Depressive Disorders: Find the full text of American Psychiatric Association guidelines.

Availability of criteria: The criteria which is used to make an authorization decision is available to the practitioners over the phone or made available in our office for proprietary criteria. Criteria used from the public domain id facilitated through a URL link or mailed copy.

Providers requesting the criteria by phone should call following numbers for each line of business –

MEDICAID & USFHP- 1-800-446-1730

HEALTH EXCHANGE (NM & TX) & MEDICARE- 1-844-282-3026