Clinical Practice Guidelines

  • Preventive Health Services Guidelines

    LifeWise has adopted the United States Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services. The guideline is evidence-based, relying on current scientific studies. Vaccinations are part of USPSTF recommendations for Preventive Health Services, and LifeWise recommends the Centers for Disease Control & Prevention (CDC) and Advisory Committee on Immunization Practices (ACIP) for an up-to-date vaccination schedule. USPSTF "A" and "B" grade services, in addition to content from other recognized sources, have been selected and formatted in two quick reference guides for provider use. These resources are available below.

    Preventive Health - Guide to Clinical Preventive Services for Adults
    Preventive Health - Guide to Clinical Preventive Services for Children/Adolescents

    HEDIS (Healthcare Effectiveness Data and Information Set)

    HEDIS is a set of nationally recognized performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS is used by over 90% of US health plans to measure quality of care, access to care, and satisfaction with care.

    If screenings are done in your office, documenting and coding these thoroughly helps assess quality care for HEDIS measurements and allows us to assess appropriate programs to assist members with health conditions. The more accurate claims are coded, the less medical record reviews are needed for HEDIS measurements. 

    Clinical Practice Guidelines

    LifeWise adopts clinical practice guidelines for the provision of non-preventive acute and chronic services relevant to its member population and for preventive and non-preventive behavioral health services. Evidence-based guidelines from recognized sources are designed to guide practitioner and member decisions about appropriate healthcare for specific clinical circumstances. LifeWise adopts evidence-based national guidelines for treatment of conditions addressed by LifeWise disease management, quality and pharmacy programs. Performance on key guidelines is measured and analyzed annually.

    LifeWise's adoption of the following guidelines does not guarantee benefit coverage for services and is not an authorization of payment for specific procedures. Members' benefits can be verified here.

    Guidelines are reviewed and approved for adoption at least every two years by LifeWise's Clinical Quality Improvement Committee. The committee's composition reflects a variety of medical and behavioral health specialties, as well as geographic regions served by LifeWise.