Clinical Practice Guidelines Update

Date: 03/07/22

In collaboration with the Department of Community Health (DCH), Peach State Health Plan updated the Clinical Practice Guidelines (CPGs) that will be included in the quarterly CPG Medical Records Audit (MRAs). The CPG MRA process assesses whether the provider’s medical practices conform to clinical standards of practice.  The audit tool serves as an instrument to gather information on the use of evidence-based clinical practice guidelines to identify the effectiveness, or lack thereof, of the treatment provided in accordance with the guidelines. 

Adopted CPGs are based on valid and reliable clinical evidence or a consensus of health care professionals in the particular field. The DCH CPG MRA audit ‘tool’ incorporates the standards, established and published by accredited sources. Members’ medical records for the following conditions will be subject to audits:

• Depression
  • APA CLINICAL PRACTICE GUIDELINE for the Treatment of Depression Across Three Age Cohorts
• Diabetes
  • American Diabetes Association | DiabetesPro Practice Guidelines Resources
• Hypertension
  • American College of Cardiology | 2017 Guideline for High Blood Pressure in Adults
  • AAFP Clinical Recommendations 
    

Click here to view the updated CPGs on the Peach State Health Plan website.

The new guidelines are effective October 1, 2021. Peach State Health Plan will begin audits for the new guideline in January 2022. If you have any questions, please contact your Provider Relations Representative or by calling 1-866-874-0633.