Clinical Practice Guidelines

Provider Clinical Practice Guidelines are evidence-based peer-reviewed expert principles based on:
· Guidelines from nationally recognized health care organizations
· Peer-reviewed published medical journals
· Evidence-based consensus statements

Provider Clinical Practice Guidelines are evaluated and updated at least annually and are available to providers. Provider Clinical Practice Guidelines are complex and intended for use by healthcare professionals. They are not intended to provide medical advice or medical care. Medical advice and care should be discussed with the treating provider. Provider Clinical Practice Guidelines do not confirm benefit coverage. Specific care and treatment may vary depending on individual need and the benefits covered under member contract. Coverage is subject to the terms and conditions of the member benefit plan and state and federal law. Authorizations reviewed by Friday Health Plans are based on MCG® and UpToDate®. To confirm benefit coverage or request a copy of a clinical guideline used to support medical necessity decisions, please contact the Friday Care Crew by calling 844-805-5000. 

New Mexico Specific:

• New Mexico Department of Health (NMDOH)
  • Website contains: 
    • COVID-19 & COVID-19 Vaccines
    • Mental Health, Substance Abuse, and Suicide Prevention
    • Maternal & Children Health
    • Injure & Infection Prevention
    • Chronic Disease

Behavioral Health Agencies

• AGORA Crisis Center
  • 1-855-505-4505
• New Mexico Crisis and Access Line
  • Crisis And Access Line
    • 1-855-622-7474
    • TTY Line: 1-855-227-5485
  • Peer to Peer Warmline
    • 1-855-466-7100
  • Healthcare Worker and First Responder Support Line
    • 1-855-507-5509
  • NM Connect App
• Mental Health and Substance Abuse/Dependence
  • New Mexico Children, Youth, and Families Department

Cultural Diversity

• Disability Rights of New Mexico
• New Mexico Indian Affairs Department

Preventative Medicine

• Smoker Cessation: Quit Now
  • 1-800-QUIT NOW 

Specialties

• Traumatic Brain Injury (TBI): NM Brain Injury Resource Center

• COVID-19 & Vaccines by Centers for Disease Control and Prevention (CDC)
  • Website contains topics including:
    • COVID-19 & COVID-19 Vaccines
    • Health Disparities
      
    • Integration of Health Literacy and Linguistic Disparity
    • Injury Prevention and Violence
      
    • Medical Conditions in Alphabetical Order
      
    • Healthy Living
      
    • Native Americans
• Coronavirus Disease 2019 (COVID-19) & COVID-19 Vaccine by Indian Health Services (IHS)
  
  • Website contains topics including:
    • COVID-19 and vaccines
    • Clinical Resources

Guidelines used by Friday to Approve Authorizations

• MCG Guidelines - requires paid subscription
• UpToDate Guidelines - requires paid subscription
• NCCN Guidelines - Oncology - requires registration for limited free access

Behavioral Health Agencies

• Crisis and Suicide:
  • National Suicide Prevention Lifeline
    • 1-800-273-8255
    • CHAT
• Mental Health and Substance Abuse/Dependence
  
  • Patient Health Questionnaire (PHQ) Screeners
    

Cultural Diversity

• US Department of Health and Human Services
  • Website includes topics on:
    • Cultural & Linguistic Competency 
    • Health and Literacy
    • Minority Population/American Indian/Alaskan Native
    • Health Equity/Disparity
    • Prevention/Wellness/Medical Conditions
    • Mental Health & Substance Abuse
    • COVID-19 and COVID-19 Vaccine
    • Immunization
    • Poison Help
    • Maternal and Child Health
    • Agencies: SAMHSA, CDC, FDA, Indian Health Services, HRSA, etc.
  • Standards of Care for the Health of Transgender and Gender Non-Conforming people. World Professional Association of Transgender Health (WPATH)
    
    • https://www.wpath.org/publications/soc

Native Americans

• Federally Recognized Indian Tribes and Resources for Native Americans
  • Topics include:
    • Resources for Native Americans
    • Links to other websites with Native American Resources
      

Preventative Medicine

• Immunizations:
  • CDC Immunization Schedule
  • UN Preventative Services Task Force A and B Recommendations
• Smoking Cessation
  • Smokefreeteen

Primary Healthcare Provider

• Asthma: Global Initiative for Asthma (GINA) Reports
• Blood Pressure: Guideline Made Simple for High Blood Pressure Adults 2017
• Cholesterol: Guideline Made Simple on the Management of Blood Cholesterol 2018
• COPD: Global Initiative for Chronic Obstructive Lung Disease (GOLD)
• Diabetes: Standards of Medical Care in Diabetes

Specialties

• Cardiology: 2017 Focused Update of Guidelines for the Management of Heart Failure: http://www.onlinejacc.org/content/70/776
• Children:
  • Identification, Evaluation, and Management of Children with Autism Spectrum Disorder
  • Promoting Optimal Development: Identifying infants and young children with developmental setbacks through developmental surveillance and screening
  • Recommendations for Preventative Pediatric Health Care
    • Website contains following topics:
      
      • Preventative Care & Periodicity Schedule
      • Bright Future Guidelines
      • Maternal Depression during Pregnancy and After Birth
      • Levels of Neonatal Care
• Infectious Diseases: Infectious Diseases Society of America (IDSA) Practical Guidelines
  • https://www.idsociety.org/practice-guideline/practice-guidelines/#/+/0date_na_dt/desc/