New Claims System Update
Guidelines for Clinical Practice Adopted by IntegraNet Health
IntegraNet Health endorses the use of evidenced-based clinical guidelines to ensure providers are providing care to health plan members that are consistent with nationally recognized protocols.
Clinical practice guidelines are statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Rather than dictating a one-size-fits-all approach to patient care, clinical practice guidelines offer an evaluation of the quality of the relevant scientific literature, and an assessment of the likely benefits and harms of a particular treatment. This information enables health care clinicians to select the best care for a unique patient based on his or her preferences.
The guidelines for clinical practice require a consistent and uniform approach to their development, accomplished through the following objectives:
NOTE: When a practitioner encounters challenges with overseeing patients with complex healthcare needs when following clinical practice guidelines and nationally recognized protocols, the practitioner should contact the IntegraNet Health Medical Director at (281) 591-5289. The Medical Director will assist with challenges and make appropriate recommendations and/or referrals.
Practitioners are encouraged to submit clinical care guidelines that are not listed. Recommendations will be presented to the QMOC and CCPB for adoption consideration.
Adopted protocols are integrated in the Provider Portal to serve as a resource guide for IntegraNet staff. The clinical practice guidelines are resources for IntegraNet Health participating physicians and other contracted healthcare professionals. IntegraNet has adopted the following guidelines: