Illinois Provider Best Practice Guidelines

Clinical practice guidelines are designed to guide decisions about diagnosing and treating specific health conditions. These guidelines are based on scientific evidence, medical literature reviews, or evidence‑based expertise. All recommendations are grounded in published guidelines and do not prioritize treatments based solely on cost. These guidelines serve as a guide for clinical decision-making, but clinicians and patients must collaborate to create individualized treatment plans tailored to each patient's unique needs and circumstances. Molina reviews these guidelines quarterly and updates them as new clinical evidence emerges. After review and necessary modifications by the Quality Improvement and Health Outcomes Committee (QI-HOC), providers are notified of any changes via fax and/or mail. Clinical guidelines are not used by Molina to determine benefit coverage. Instead, they are educational tools to aid clinical decision-making and are not considered a standard of care. Physicians should adapt the guidelines based on their clinical judgment. To request a copy of any guideline, please contact Molina Provider Services.