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Care Management Guidelines

Clinical Practice Guidelines

Community Health Plan and its providers use guidelines for care written by experts in the field of medicine and behavioral health. These guidelines help providers to know when to use certain treatments and what problems to look out for.

These resources can include Milliman Care Guidelines®, Medicare coverage determinations, national standards, the expertise of board-certified practitioners in applicable specialties, and Community Health Plan clinical coverage criteria documents. These sources are equally weighted in consideration.

These nationally accepted standards based on evidence are available to providers and by request to Community Health Plan members.

To read the standards online, you can visit the Community Health Plan providers website. IMPORTANT: This link takes you to the provider website. Please use your back button or use the orange tabs at the top of the screen to return to the member website.

If you want paper copies of standards or you want someone to read them to you, please call the Community Health Plan customer service team at 1-800-440-1561, Monday through Friday from 8:00 am to 5:00 pm, or email customercare@chpw.org. If you are hearing or speech impaired, please call TTY Relay: Dial 7-1-1.