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.
USFHP- 1-800-678-7347 ( 711 for TTY users).
Health Exchange (NM & TX) -1-844-282-3026 ( 711 for TTY users).
Medicare - 1-844-282-3026 ( 711 for TTY users).
Hours
Health Insurance Exchange: 8 a.m. to 5 p.m., local time, Mon. – Fri.
Medicare Advantage: 8 a.m. to 8 p.m., local time, 7 days a week, Oct. 1 – Mar. 31; and 8 a.m. to 8 p.m., local time, Mon. – Fri.
USFHP: 8 a.m. to 5 p.m., Mon. – Fri.