Clinical Guidelines

Clinical Practice Guidelines and Recommendations

Adult Behavioral Health Guidelines

Adult Hypertention Management Guidelines (NHLBI)

• INC 7 Report on Prevention, Detection, Evaluation and treatment high blood pressure.

Adult Obesity Management Guidelines (NHLBI and NIDDKD)

• Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.

Asthma & COPD Management Guidelines (NHLBI)

• Guidelines for the Diagnosis and Management of Asthma
• COPD Guidelines

Cardiac and CVA Care Management (ACC/AACE)

• NCEP III Guideline

Childhood Behavioral Health Guidelines

Chronic Pain Management Guidelines (American Pain Society)

• Clinical Practice Guidelines

Diabetes Management Guidelines (ADA)

• Clinical Practice Guidelines

General Infectious Disease Management Guidelines (IDSA)

• Clinical Practice Guidelines

HIV Management Guidelines

• CDC/NIH
• IDSA

Pediatric Obesity Management Guidelines (NHLBI and NIDDKD)

• Childhood Obesity

Smoking Cessation Guidelines (NIH)

• Tobacco Cessation

Medical Determination Criteria

BCBSAZ Health Choice’s clinical and medical management teams use national guidelines and resources when making medical determinations. The resources include, but are not limited to:

• InterQual Guidelines
• CMS National Coverage Determination
• CMS Local Coverage Determination
• Hayes Knowledge Center, INC.
• UptoDate
• Plan Developed Clinical Policies
  • 2023 Health Choice Behavioral Health Inpatient Facility Criteria for persons under 21
  • 2023 Health Choice Behavioral Health Residential Facility Criteria – Adults and Children
  • 2023 Health Choice Adults Behavioral Health Therapeutic Homes
  • 2023 Health Choice Therapeutic Foster Care for Children

To obtain BCBSAZ Health Choice’s national and state recognized medical necessity criteria applied to behavioral health and medical decisions, please contact 1-800-322-8670 (TTY: 711).