Skip to Main Content

Policies and Guidelines


Clinical Guidelines

Clinical guidelines are intended to be used to encourage quality patient care, but cannot guarantee specific patient outcome, and should be used only as a reference guide. The guidelines are not intended to replace a clinician's own judgment with regard to the care needed by individual members or to establish protocols for the care of all members. Coverage of specific services may vary based on the terms of specific member/enrollee contracts (including state and federal government program contracts), administrative policies, and state/federal mandates.

ICSI Guidelines

An Institute for Clinical Systems Improvement (ICSI) guideline represents best practice for prevention and treatment of health conditions. These are intended to improve the effectiveness, efficiency and consistency of patient care, and provide a common foundation for clinical improvement initiatives.

ICSI guidelines assist clinicians by providing an analytical framework for the evaluation and treatment of patients. They are not intended to replace a clinician's judgment or to establish a protocol for all patients with a particular condition.

NOTE: The below links are to the individual guideline summary pages. To view the complete guideline once you are on a summary page, click on “View Guideline” at the right.

Medica Guidelines

Medica clinical guidelines are developed using an evidence-based approach analyzing scientific literature and input from practicing physicians, Care Management staff and Medica Medical Directors. Documents are updated as necessary.

A Medica clinical guideline, adapted from regional or national credible sources, is used by physicians in the network as a reference guide to encourage quality care. Clinical guidelines are used internally at Medica to develop member education materials, disease management recommendations, and various quality studies. These guidelines are in addition to the guidelines that Medica has adopted from ICSI.


Management of Benign Uterine Conditions (VI-GYN.01)


Preventive Services for Children and Adolescents Enrolled in Medica Choice Care, Medica AccessAbility Solution and Medica MinnesotaCare (VI-PRV.01)

Date: 12/15/2017 2:07:19 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CMSWEB01