Clinical 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 Committee and then they are disseminated to providers.

Adult Immunizations

Adult and Child Preventive Screenings

Asthma 

Child Immunizations

Congestive Heart Failure (CHF)

Diabetes

Early Childhood Cavities Prevention (ECCP)

Obesity

Oral Health in Pregnancy

Osteoporosis

Pediatric Preventive Screenings

Stable Ischemic Heart Disease (SIHD)

Tobacco Cessation

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 

Immunizations Guidelines 

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