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TRICARE Prime® Demo by CareSource Military & Veterans™ approves and adopts evidence-based nationally accepted standards and clinical practice guidelines (CPGs) to help inform and guide the provision of clinical care to beneficiaries. CPGs do not create new benefits or coverage rules and shall not supersede or replace the requirements of the TRICARE Policy Manual, TRICARE Reimbursement Manual, or TRICARE Operations Manual. In all cases, TRICARE coverage policy and contractual requirements govern coverage determinations. CPGs are identified through review of beneficiary population demographics and state/national priorities. They are reviewed quarterly and updated as necessary.
The use of these guidelines allows us to measure their impact on beneficiary health outcomes. Review and approval of the guidelines are completed by the Market TRICARE Prime Demo Provider Advisory Committee (PAC) and the TRICARE Prime Demo Enterprise PAC. The Quality Enterprise Committee (QEC) is notified of guideline approval. We identify guideline topics through analysis of beneficiary population demographics and national or state priorities. Guidelines may include, but are not limited to:
- Behavioral health (e.g., depression, anxiety and post-traumatic stress disorder PTSD)
- Adult health (e.g., hypertension and diabetes)
- Population health (e.g., obesity and tobacco and vaping cessation)
Guidelines may be promoted to providers through one or more of the following: our website, direct mailings, provider manual, and through focused meetings with our Provider Engagement Specialists. A broad range of wellness, preventive health and chronic disease management tools are also available on the CareSource Military & Veterans (CSMV) beneficiary website or upon request.
Clinical Practice Guidelines
| Health Condition | Clinical Guideline |
|---|---|
Anxiety | Generalized Anxiety Disorder and Panic Disorder in Adults American Academy of Family Physicians |
Perinatal Care – At Risk Newborn | Neonatal Care: A Compendium of AAP Clinical Practice Guidelines and Policies AAP Books | American Academy of Pediatrics |