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Clinical Guidelines

Provider Administrative Policy

Care Management
Policy Date
April 2007
Revised/May 2008


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


Clinical Guidelines

Blue Cross of Idaho endorses the use of evidence-based national guidelines for the treatment of medical conditions included in our disease management, quality and pharmacy programs. The clinical practice guidelines we endorse were developed by nationally recognized professional organizations, including, but not limited to:

  • American Diabetes Association (ADA)
  • National Heart, Lung, and Blood Institute (NHLBI)
  • American Psychology Association (APA)
  • National Asthma Education and Preventive Program (NAEPP)
  • American College of Cardiology (ACC)
  • American Heart Association (AHA)
  • Agency for Healthcare Research and Quality (AHRQ)

You may download and print these guidelines at this link:  Clinical Guidelines.

All guidelines are reviewed by our Clinical Quality Management committee and are reviewed by the Blue Cross of Idaho Physician's Advisory panel no less than annually.

The guidelines are not intended to dictate clinical care but are intended as an important and useful aid in delivering high-quality, evidence-based medical care to Blue Cross of Idaho's members. We recognize that in individual clinical situations there may be patient- or delivery system-specific reasons to deviate from the guidelines.

Clinical practice guidelines may include treatment that is not covered by a member's benefits. Benefit information can be obtained by calling Customer Service using the phone number printed on the back of the member's identification card.

Policy History

Date Action Reason
May 2008 Revised Language clarification

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