Clinical Guidelines
UnitedHealthcare uses evidence-based clinical guidelines from nationally recognized sources to guide our quality and health management programs.
Acute Myocardial Infarction with ST Elevation – Clinical Guideline
Last Published 04.17.2020
This guideline outlines the recognition of potential risks, acute/long term management, procedural interventions and pharmacotherapy of patients with ST elevation myocardial infarction (STEMI).
Acute Myocardial Infarction without ST Elevation – Clinical Guideline
Last Published 04.17.2020
This guideline outlines the recognition of potential risks, acute/long term management, procedural interventions and pharmacotherapy of patients without ST elevation myocardial infarction (non-STEMI).
Asthma – Clinical Guideline
Last Published 04.21.2020
These guidelines outline the diagnosis and management of asthma.
Atrial Fibrillation – Clinical Guideline
Last Published 04.17.2020
This clinical guideline addresses recommendations for the optimum management of atrial fibrillation.
Attention Deficit/Hyperactivity Disorder (ADHD) – Clinical Guideline
Last Published 04.20.2020
This guideline outlines the evaluation, diagnosis, and treatment of ADHD in children from age 4 to 18, with special guidance provided for ADHD care for preschool-aged children and adolescents.
Behavioral Health – Clinical Guideline
Last Published 04.20.2020
This guideline outlines several topics related to behavioral health.
Cardiology and Radiology: Imaging Guidelines – Commercial
Last Published 06.03.2020
This guideline outlines current, evidence-based recommendations regarding cardiology and radiology.
Cardiology and Radiology: Imaging Guidelines – Community Plan
Last Published 06.03.2020
This guideline outlines current, evidence-based recommendations regarding cardiology and radiology.
Cardiology and Radiology: Imaging Guidelines – Medicare Advantage
Last Published 06.03.2020
This guideline outlines current, evidence-based recommendations regarding cardiology and radiology.
Cardiovascular Disease: Lifestyle Management to Reduce Cardiovascular Risk – Clinical Guideline
Last Published 04.20.2020
This guideline presents evidence that particular dietary patterns, nutrient intake and levels and types of physical activity can play a major role in cardiovascular disease prevention and treatment through effects on modifiable risk factors such as blood pressure and lipids.
Cardiovascular Disease: Primary Prevention – Clinical Guideline
Last Published 04.21.2020
This guideline addresses the primary prevention of cardiovascular disease in adults.
Cholesterol Management – Clinical Guideline
Last Published 04.17.2020
This guideline outlines recommendations to address the practical management of individuals with high blood cholesterol and related disorders.
Chronic Obstructive Lung Disease – Clinical Guideline
Last Published 04.17.2020
These practice parameters detail the assessment and treatment modalities for individuals with chronic obstructive lung disease.
Dementia – Clinical Guideline
Last Published 04.20.2020
This guideline outlines the general and specific treatment recommendations for patients with Alzheimer’s disease and other dementias.
Diabetes – Clinical Guideline
Last Published 04.21.2020
This clinical guideline outlines the care of the diabetic patient including screening, diagnosis, and treatment options.
Dietary Guidelines – Clinical Guideline
Last Published 04.17.2020
This guideline provides information and advice for choosing a healthy eating pattern that focuses on nutrient-dense foods and beverages and contributes to achieving and maintaining a healthy weight.
Fertility Solutions Medical Necessity Clinical Guideline: Infertility
Last Published 02.13.2020
This guideline provides an evidence-based approach to infertility management, infertility surgery, and the use of single embryo transfer in addition to describing the limitations of and recommendations for infertility treatment.
Heart Failure – Clinical Guideline
Last Published 04.17.2020
This guideline outlines the stages of heart failure and describes a range of generally acceptable approaches for the diagnosis, management and prevention of heart failure.
Hemophilia – Clinical Guideline
Last Published 04.20.2020
This guideline outlines the diagnosis, management and treatment of hemophilia.
Human Immunodeficiency Virus (HIV) – Clinical Guideline
Last Published 04.21.2020
These guidelines outline the management of adults and adolescents infected with HIV.
Hypertension – Clinical Guideline
Last Published 04.17.2020
This clinical guideline addresses the prevention, detection, evaluation and management of high blood pressure in adults.
Kidney Disease – Clinical Guideline
Last Published 04.17.2020
This guideline outlines evidence-based recommendations to aid clinicians in the treatment of particular diseases or groups of patients for all stages of chronic kidney disease (CKD) and related complications.
Mechanical Circulatory Support Devices (MCSD) – Clinical Guideline
Last Published 04.01.2020
This guideline outlines the indications, minimum evaluation requirements, contraindications, and special considerations for the use of long-term, durable mechanical circulatory support devices (MCSD).
Neonatal Resource Services Medical Necessity Clinical Guideline: Apnea and Bradycardia
Last Published 02.11.2020
This guideline outlines how to determine the optimal course of treatment and subsequent case management of the neonate with neonatal apnea.
Neonatal Resource Services Medical Necessity Clinical Guideline: Chronic Care
Last Published 02.17.2020
This guideline outlines the management of the infant with unresolved medical needs that require ongoing skilled medical care.
Neonatal Resource Services Medical Necessity Clinical Guideline: Discharge Planning
Last Published 02.17.2020
This guideline outlines discharge planning to home for the infant in the NICU.
Neonatal Resource Services Medical Necessity Clinical Guideline: Early-Onset Neonatal Sepsis
Last Published 02.11.2020
This guideline outlines how to determine the optimal course of treatment and subsequent case management of early-onset neonatal sepsis (EONS).
Neonatal Resource Services Medical Necessity Clinical Guideline: Feeding the Neonate
Last Published 02.17.2020
This guideline provides a protocol for feeding of high-risk and premature neonates.
Neonatal Resource Services Medical Necessity Clinical Guideline: Hyperbilirubinemia
Last Published 02.17.2020
To provide guidelines on the identification and optimal management of infants with neonatal hyperbilirubinemia.
Neonatal Resource Services Medical Necessity Clinical Guideline: Inhaled Nitric Oxide (iNO) - Community Plan
Last Published 04.10.2020
This guideline provides an evidence-based guideline for the use of inhaled nitric oxide (iNO) in the infant population.
Neonatal Resource Services Medical Necessity Clinical Guideline: Neonatal Abstinence Syndrome (NAS)
Last Published 02.17.2020
This guideline outlines monitoring and management of neonates with intrauterine exposure to illicit substance and for treatment of infants with neonatal abstinence syndrome (NAS)."
Neonatal Resource Services Medical Necessity Clinical Guideline: Synagis (palivizumab)
Last Published 02.17.2020
This guideline provides an evidence-based guideline for utilization of Synagis in infants and young children.
Neonatal Resource Services Medical Necessity Clinical Guideline: Thermoregulation
Last Published 02.17.2020
This guideline explain the importance of the principles of thermoregulation in the NICU.
Obesity – Clinical Guideline
Last Published 04.21.2020
These guidelines outline interventions and practices for maintaining a healthy weight in children, adolescents and adults.
Physical Activity – Clinical Guideline
Last Published 04.17.2020
This guideline provides information and guidance on the types and amounts of physical activity that provide substantial health benefits.
Preventive Pediatric Health Care Screening – Clinical Guideline
Last Published 04.20.2020
This guideline outlines the recommendations for preventive pediatric care from infancy to adolescence.
Preventive Services – Clinical Guideline
Last Published 04.21.2020
A collection of evidence-based recommendations on clinical preventive services such as screenings, counseling services and preventive medications.
Sepsis – Clinical Guideline
Last Published 04.17.2020
This guideline outlines the early management and resuscitation of patients with sepsis or septic shock and includes the definition of sepsis/septic shock.
Sickle Cell Disease – Clinical Guideline
Last Published 04.17.2020
This guideline outlines the management of patients with sickle cell disease.
Stable Ischemic Heart Disease – Clinical Guideline
Last Published 04.17.2020
This guideline is intended to apply to adult patients with stable known or suspected ischemic heart disease, including new-onset chest pain (i.e., low-risk unstable angina), or to adult patients with stable pain syndromes.
Tobacco Use – Clinical Guideline
Last Published 04.21.2020
This decision pathway addresses the assessment of cigarette smoking and nicotine dependence, as well as behavioral, pharmacological, and supportive interventions that can be used in both inpatient and outpatient settings.
Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation
Last Published 01.09.2020
This guideline outlines general information, indications, organ-specific contraindications, and special considerations for hematopoietic stem cell transplantation.
Transplant Review Guidelines: Solid Organ Transplantation
Last Published 04.01.2020
This guideline outlines general information, indications, universal and organ-specific contraindications, and special considerations for solid organ transplantation.
Violence and Abuse – Clinical Guideline
Last Published 04.20.2020
This guideline outlines the physicians’ responsibility in promoting the well-being of patients.
For questions, please contact your local Network Management representative or call the Provider Services number on the back of the member’s ID card.