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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.

If you would like a printed copy of this information, please contact your Network Specialist.

Members may request a printed copy of this information by calling the Member Services number on the back of their ID card.

This content was last revised on May 15, 2023 and may be subject to change.