Clinical Practice Guidelines
At Horizon, we follow clinical and preventive guidelines for our Disease Management Programs and for the care we give to our members. These guidelines are determined by evidence-based medicine and rigorous review of published medical literature. Our medical policies (Medical Policy Manual) are adopted and approved by the Medical Policy Committee at Horizon Blue Cross Blue Shield of New Jersey as well as by the Utilization Management and Continuous Quality Improvement Committees. At Horizon. Pre-authorizations and/or authorizations of all medical services are conducted using one of the following Horizon approved approaches: MCG criteria or Horizon Medical Policies.
American Society of Addiction Medicine (ASAM) criteria will be used when making coverage determinations for services related to Substance Use Disorders.
Click a topic below to review the clinical guideline information for that topic.
National Heart, Lung and Blood Institute’s (NHLBI) 2020 Focused Updated to the Asthma Management Guidelines
2017 ACC/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
2013 ACCF/AHA Guideline for the Management of Heart Failure A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines 2.
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification
Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2021.
American Psychiatric Association (APA) Psychiatric
American Diabetes Association (ADA) Clinical Practice Guidelines (2021)
Hypertension 2017 Clinical Practice Guidelines
2020 International Society of Hypertension Global Hypertension Practice Guidelines
Agency for Healthcare Research and Quality: Obesity
State of New Jersey Department of Health Prenatal Care
Bone Source Clinical Guidelines
Centers for Disease Control and Prevention tools from Former Smokers Healthcare Providers: Tools and Resources
If you would like a printed copy of this information, please contact your Network Specialist.
This content was last revised on March 24, 2022 and may be subject to change.