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Clinical Practice Guidelines

Meridian encourages the use of evidence-based Clinical Practice Guidelines (CPGs) by our providers. Our Quality Improvement Committee approves and adopts CPGs for prevention, diagnosis and management of medical and behavioral health conditions. These guidelines are developed by the nationally-recognized National Committee for Quality Assurance (NCQA), MQIC or other CPG developers to develop clinical strategies to monitor and evaluate the quality of care provided to Medicare beneficiaries.

NCQA guidelines are reviewed and updated quarterly, or more frequently if necessary. Once approved by NCQA Medical Directors, CPGs are sent to the National Guideline Clearinghouse (NGC) for inclusion on the US Department of Health and Human Services Agency for Healthcare Research and Quality. NGC prepares structured abstracts for consistency of guidelines on their website.

Meridian promotes implementation of these CPGs via dissemination among practitioners and uses numerous performance measures to provide feedback to achieve consistent and high quality health outcomes for our members.

The CPGs are reviewed at least every two years and updated as necessary by the Meridian Health Plan Physician Advisory Committee (PAC), and approved by Meridian's Quality Improvement Committee and Board of Directors.

Please click below to view the guidelines in electronic format. They are also available in hard copy upon request by contacting the Medicare Quality Improvement department at 1-855-898-1470.

NCQA guidelines are now available through a free mobile app. Search "NCQA" in the App Store or Google Play and all guidelines can be downloaded right to your phone or tablet.

Recently Updated Clinical Practice Guidelines

Medical

Behavioral Health

Updated Date: 10/01/24

H6080_WEBSITE_2025_Accepted_09302024


Updated Date: 10/01/24

H6080_WEBSITE_2025_Accepted_09302024

Meridian Medicare-Medicaid Plan (MMP) is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Meridian Member Handbook. Out-of-network/non-contracted providers are under no obligation to treat Meridian members, except in emergency situations. Please call our Member Services number or see your Member Handbook for more information, including the cost-sharing that applies to out-of-network services. You can get this document for free in other formats, such as large print, braille, or audio. Call 1-855-580-1689 (TTY: 711). Representatives are available Monday-Friday, 8 a.m. to 8 p.m. to assist you. On weekends and on state or federal holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

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