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  • Clinical Practice Guidelines > Overview

    EmblemHealth encourages the use of Clinical Practice Guidelines (CPGs) for assistance in the treatment of acute, chronic and behavioral health issues. We've adopted these guidelines from professionally recognized sources and through consultation between board-certified specialists and our Health Status Improvement Subcommittee.

    All CPGs are reviewed at a minimum of every two years and are updated as appropriate. (The HIV/AIDS CPGs are reviewed and updated annually.)

    CPGs are not intended as a substitute for the professional assessment of the health care practitioner but to assist the practitioner in the management of certain types of preventive and clinical care. Individual patient treatment may vary from these guidelines based on the health care practitioner's clinical judgment.

    The CPGs approved by EmblemHealth are listed below. Updates will be posted regularly to our Web site, so please check for updates on a monthly basis. If you are unable to access a specific CPG on the Web, please contact our Quality Management department at 1-888-447-5451 to request a mailed copy.

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    Glossary terms found on this page:

    Conditions that affect thinking and the ability to figure things out that affect perception, mood and behavior.

    Services rendered by a physician whose opinion or advice is requested by another physician for further evaluation or management of the patient.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.


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