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:

  • Oversight by IntegraNet’s Chief Medical Officer, or designee, and direct involvement of the Quality Management Oversight Committee (QMOC)
  • Guidelines are available to all applicable practitioners on the IntegraNet Health website.
  • Clinical guidelines will be researched, adopted, and distributed to ensure the most current clinical practices are in place for the treatment of our Health Plan members. All practice guidelines will be presented to the Care Coordination Policy Board (CCPB) for adoption.
  • 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:



    Adult Immunizations Centers for Disease Control & Prevention
    Alcoholism National Institute on Alcoholism
    Asthma Care Global Initiative for Asthma
    Atrial Fibrillation AHA/ACC/Heart Rhythm Society
    Back Pain AAFP Foundation
    Behavioral Health Optum
    Cardiovascular Disease – Prevention ACC/AHA
    Chest Pain AHA/ACC
    Child & Adolescent Immunizations Centers for Disease Control & Prevention
    Childhood Preventive Services Centers for Disease Control & Prevention
    Cholesterol Treatment Department of Veterans Affairs Department of Defense
    Chronic Obstructive Pulmonary Disease Global Initiative for COPD
    COVID-19 National Library of Medicine
    Dementia American Psychiatric Association
    Diabetes American Diabetes Association
    Headache/Migraine Veterans Affairs/Department of Defense
    Heart Failure AHA Journals
    Human Immunodeficiency Virus (HIV) Centers for Disease Control & Prevention
    Hypertension 2020 International Society of Hypertension
    Irritable Bowel Syndrome The American Journal of Gastroenterology
    Kidney Disease National Kidney Foundation
    National & Local Coverage Determinations Centers for Medicare & Medicaid Services
    National Guideline Clearinghouse National Guideline Clearinghouse
    Obesity Veterans Affairs/Department of Defense
    Opioids for Chronic Pain AAFP Foundation
    Physical Activity Office of Disease Prevention & Health Promotion
    Preventive Services U.S. Preventative Services Task Force
    Sepsis National Library of Medicine
    Sickle Cell Disease American Society of Hematology
    Stroke Stoke Association
    Tobacco Use American College of Cardiology Task Force
    Upper Respiratory Infections Centers for Disease Control & Prevention
    Urinary Tract Infection (Bacteriuria) Infectious Diseases Society of America
    Violence & Abuse AMA Code of Medical Ethics