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Clinical guidelines and policy bulletins

Guidelines

 

Respected medical professional and public health organizations create clinical practice guidelines that document best practices and recommendations for care. We’ve chosen certain clinical guidelines to help our providers give members high-quality, consistent care with effective use of services and resources. These include treatment protocols for specific conditions, as well as preventive health measures to promote guidelines that support the overall physical and mental health of our members.

 

The intention of these guidelines is to clarify standards and expectations. They should not: 

 

  • Take precedence over your responsibility to provide treatment based on the member’s needs

  • Substitute as orders for treatment of a member

  • Guarantee coverage or payment for the type or level of care proposed or provided

 

Below is a list of Aetna Better Health recommended clinical practice guidelines by topic. These guidelines originated from the Michigan Quality Improvement Consortium (MQIC) and the Aetna Medicaid Medical Policy Committee (MMPC). MQIC and MMPC participants include physicians and other personnel representing the Michigan Medicaid Health Plans (MMHPs). The Michigan Association of Health Plans and the Aetna Medicaid Medical Committee recognize the expertise and evidence-based knowledge these guidelines represent and encourage the use of accepted standards of care to promote quality care and better health outcomes for our members.

Clinical practice guidelines

Clinical policy bulletins

These bulletins state our policy about the medical necessity or investigational status of medical technologies and other services to help with coverage decisions. A national review team creates the bulletins and bases them on:

 

  • Published medical literature

  • Formal technology assessments

  • Structured evidence reviews 

  • Evidence-based consensus statements

  • Expert opinions 

  • Evidence-based guidelines from professional and public health entities 

 

 

Aetna® clinical policy bulletins

 

Instructions for Accessing Aetna Supplemental Criteria Guidelines (PDF)

  

Medicare Part B Drug Requirements/Guidelines

Clinical policy bulletins

 

These bulletins state our policy about the medical necessity or investigational status of medical technologies and other services to help with coverage decisions. A national review team creates the bulletins and bases them on:

 

  • Published medical literature

  • Formal technology assessments

  • Structured evidence reviews 

  • Evidence-based consensus statements

  • Expert opinions 

  • Evidence-based guidelines from professional and public health entities 

 

 

Aetna® clinical policy bulletins

 

Instructions for Accessing Aetna Supplemental Criteria Guidelines (PDF)

  

Medicare Part B Drug Requirements/Guidelines

Also of interest:

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