Clinical Practice Guidelines

UCare’s clinical practice guidelines includes the primary source with a direct link to online content, modifications (if needed) for our unique populations, rationale for modifications and additional references if available.

MEDICAL

UCare, through the Quality Improvement Advisory and Credentialing Committee (QIACC), adopts medical clinical practice guidelines from nationally or locally recognized sources. Sources may include medical specialty societies and other professional organizations. The guidelines are based on reasonable medical evidence or a consensus on clinical treatment patterns by physicians in the selected field of practice.

Asthma, Diagnosis and Management
Primary Source: Global Initiative for Asthma

Diabetes, Type 2; Diagnosis and Management
Primary Source: American Diabetes Association

Management of Heart Failure in Adults
Primary Source: Journal of the American College of Cardiology (JACC)

Obesity in Adults; Prevention and Management
Primary Source: American Academy of Family Physicians

Prenatal Care
Primary Source: American Academy of Family Physicians

Preventive Services for Adults
Primary Source: American Academy of Family Physicians

Preventive Services for Children and Adolescents  (Approval Mar. 22, 2018) 
Primary Source: American Academy of Pediatrics Bright Futures (AAP)

 

BEHAVIORAL HEALTH

UCare adopted five behavioral health clinical practice guidelines to support good decision-making by patients and clinicians, improve member health outcomes and meet NCQA accreditation standards. Adult guidelines are adopted from American Psychiatric Association (APA). Child and adolescent guidelines are adopted from the Journal of the American Academy of Child Adolescent Psychiatry. 

Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder
Primary Source: American Academy of Child and Adolescent Psychiatry 

Assessment and Treatment of Children and Adolescents with Depressive Disorders
Primary Source: American Academy of Child and Adolescent Psychiatry 

Treatment of Patients with Major Depressive Disorder
Primary Source: American Psychiatric Association 

Treatment of Patients with Schizophrenia
Primary Source: American Psychiatric Association 

Treatment of Patients with Substance Use Disorders (SUD)
Primary Source: American Psychiatric Association

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UCare Provider Manual Has Been Updated

2018 Provider Manual updates were made to Working with UCare's Delegated Business Services  Claims & Payment, Clinical Practice Guidelines, Member Appeals and Grievances, Home & Community Based Services, Public Health and Transportation Services. A change table in the Appendix links to specified changes in the manual. 
 

See the Provider Manual

 

 

Provider Assistance Center Phone Update

Our phone service is working, we’re continuing to monitor for any ongoing issues, please be aware we anticipate higher volumes as people catch up so we may experience longer wait times, especially on Monday. For faster assistance, please use the Provider Portal for claims, eligibility and authorization inquiries. We apologize for the inconvenience.