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Clinical Practice Guidelines
Corphealth has adopted several clinical practice guidelines (CPG) from the American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP) to assist practitioners in making decisions regarding appropriate behavioral health care for specific clinical circumstances and to ensure consistency and improve patient care and safety. These evidence-based guidelines are known to be effective in improving health outcomes. Corphealth has chosen the practice guidelines for treatment of patients with Bipolar Disorder, Major Depressive Disorder and Substance Use as our current focus guidelines in the adult population, as these diagnoses are among the most common for our members. For adolescents and children, Corphealth has selected Attention-Deficit/Hyperactivity Disorder, Depressive Disorders and Substance Use practice parameters. For your reference, these guidelines may be accessed at www.corphealth.com. You may also call 866/279-7214 to request a paper copy.
Corphealth assesses compliance with clinical practice guidelines annually. The sample selection represents 50% of the high volume practitioners in each market where Corphealth has business. High volume is defined as a practitioner who sees 10 or more enrollees three or more times in a 12 month period. Reviews are conducted in the practitioner’s office to allow for face-to-face contact and training. The performance goal is 85%. During record reviews, Corphealth will focus on two elements for each guideline. A link for those elements is provided below.
Please note: The clinical practice guidelines are not a substitute for the sound clinical judgment of the behavioral health care practitioner and are intended only to assist the practitioner in making decisions about appropriate health care for specific clinical circumstances. Clinical practice guidelines may include treatment that requires prior authorization and/or may not be covered by the member’s health plan. All authorizations for care are based on medical necessity and are applied within the benefit plan structure.
Bipolar Disorder
APA Bipolar Disorder Practice Guidelines
Handout: Learn More about Bipolar Disorder
Major Depressive Disorder
APA Major Depressive Disorder Practice Guidelines
AACAP Depressive Disorders Practice Parameters
Guideline for Diagnosis and Treatment of Depression
Handout: Learn More about Major Depressive Disorder
Substance Abuse
APA Substance Use Disorders Practice Guidelines
AACAP Substance Use Disorders Practice Parameters
Attention-Deficit/Hyperactivity Disorder
AACAP ADHD Practice Parameters
Corphealth ADHD Practice Parameters Addendum
Elements for Annual Performance Measures
Corphealth Elements for Annual Performance Measures
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