Clinical Guidelines

For members

BCBSAZ Health Choice uses clinical practice guidelines when making important decisions about keeping you and your family healthy.

We also provide the support needed to be sure your primary care provider, specialists, and other health care providers involved in your care work closely with you on treatment plans for your individual needs.

We encourage members to call BCBSAZ Health Choice Member Services at 1-800-322-8670 with specific questions relating to your care.

Clinical Practice Guidelines and Recommendations

Adult Behavioral Health Guidelines

Adult Hypertention Management Guidelines (NHLBI)

• INC 7 Report on Prevention, Detection, Evaluation and treatment high blood pressure.

Adult Obesity Management Guidelines (NHLBI and NIDDKD)

• Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults.

Asthma & COPD Management Guidelines (NHLBI)

• Guidelines for the Diagnosis and Management of Asthma
• COPD Guidelines

Cardiac and CVA Care Management (ACC/AACE)

• NCEP III Guideline

Childhood Behavioral Health Guidelines

Chronic Pain Management Guidelines (American Pain Society)

• Clinical Practice Guidelines

Diabetes Management Guidelines (ADA)

• Clinical Practice Guidelines

General Infectious Disease Management Guidelines (IDSA)

• Clinical Practice Guidelines

HIV Management Guidelines

• CDC/NIH
• IDSA

Pediatric Obesity Management Guidelines (NHLBI and NIDDKD)

• Childhood Obesity

Smoking Cessation Guidelines (NIH)

• Tobacco Cessation

Medical Determination Criteria

BCBSAZ Health Choice’s clinical and medical management teams use national guidelines and resources when making medical determinations. The resources include, but are not limited to:

• InterQual Guidelines
• CMS National Coverage Determination
• CMS Local Coverage Determination
• Hayes Knowledge Center, INC.
• UptoDate
• Plan Developed Clinical Policies
  • 2023 Health Choice Behavioral Health Inpatient Facility Criteria for persons under 21
  • 2023 Health Choice Behavioral Health Residential Facility Criteria – Adults and Children
  • 2023 Health Choice Adults Behavioral Health Therapeutic Homes
  • 2023 Health Choice Therapeutic Foster Care for Children

To obtain BCBSAZ Health Choice’s national and state recognized medical necessity criteria applied to behavioral health and medical decisions, please contact 1-800-322-8670 (TTY: 711).