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Clinical Practice Guidelines

Evidence-based clinical practice guidelines are developed to assist providers and members in making decisions about appropriate health care for specific clinical circumstances including “self-management” of chronic diseases.  The guidelines are intended to improve the quality and consistency of care provided at the provider level.  A physician champion is utilized in the development of these guidelines prior to the approval of each guideline by our Quality Management Council and then they are disseminated to providers.

Adult Immunizations

Adult and Child Preventive Screenings 

Asthma

Child Immunizations

Congestive Heart Failure

Diabetes

Heart Disease

Hypertension

Obesity

Oral Health in Pregnancy

Osteoporosis

Pediatric Preventive Screenings

Tobacco Cessation

Behavioral Health Guidelines

Samaritan Health Plans’ partners in behavioral health and substance use disorder follow evidence-based clinical practice guidelines that are in alignment with the American Psychiatric Association (APA) and the American Society of Addiction Medicine (ASAM) guidelines:

APA’s Clinical Practice Guidelines
ASAM’s Clinical Guidelines

The Oregon Health Authority (OHA) recommends telehealth for most community behavioral health delivery during the COVID-19 pandemic. The OHA Public Health Recommendation for Community Behavioral Health Services is a tool to help with decision-making regarding the use of in-person versus telehealth clinical services and provides guidance on mitigating the risk of infection as well.  

Dental Health Guidelines

Samaritan Health Plans’ Dental Care Organization (DCO) partners follow evidence-based clinical practice guidelines that are in alignment with American Dental Associations (ADA) clinical practice guidelines list:

ADA’s Clinical Practice Guidelines

Preventive Care and Immunization Guidelines

These guidelines are comprised of recommendations from the United States Preventive Services Task Force (USPSTF) and the Centers for Disease Control (CDC):

Preventive Care Services Guidelines (Updated September 2021)

Immunizations Guidelines (Updated January 2021)

Annual Preventive Exams for Medicare Patients

Below is a side-by-side comparison of the Welcome to Medicare Visit, Annual Wellness Visits, and Preventive Medicine Services codes. Samaritan Advantage Health Plan covers all of these codes (G0402, G0438, G0439, and 99381-99429). When billing SAHP with these codes, there is a $0.00 cost share to the Samaritan Advantage  member. It is at the discretion of the provider to provide and code the appropriate level of a preventive comprehensive physical exam for the Medicare patient. Samaritan Health Plans encourages providers to conduct a full annual comprehensive exam (99381-99429).

Annual Preventive Exams for Medicare Patients