Clinical Resources

Programs & Benefits

• Bright Start, our healthy pregnancy program
• Complementary and Alternative Medicine (CAM) and “In Lieu Of” Benefits
• Case Management
• Disease Management
• Health@Home, our home based primary care program
• Pyx Health App – 24/7 access to physical and mental well-being resources and support for Medicaid and Commercial members  (pdf flyer in English and Spanish)

Quality Improvement

• • Care for Older Adults (COA) – Updated March 14, 2023
  • 2023 Provider Clinical Quality Measure Guide– Updated May 17, 2023
  • HEDIS Plan All-Cause Readmissions (PCR) Measure Guide – Updated July 10, 2023

Coding Best Practices

Errors and mistakes in coding can cause many issues including the inability to properly track and classify members in your patient panel. Correctly coding to the highest level of specificity is important in helping you document and tracking your patients’ conditions. See the following measure best practices to assist you in coding to the highest level of specificity.

• • • CPT II Coding
    • Diabetes
    • Hypertension
    • Depression
    • Telehealth
    • Remission Coding Education

Neighborhood Clinical Practice Guidelines

Listed is a complete set of Neighborhood’s Clinical Practice Guidelines, based upon the most current available medical information and developed with the assistance of physicians affiliated with Neighborhood. The Guidelines are not intended to replace a clinician’s judgment or to determine benefits administration; rather, they are designed to assist you in the diagnosis and treatment of some of the more common problems of your patients.

Since guidelines are dynamic tools it is important to note that, over time, Neighborhood may periodically revise them. Neighborhood will inform you of the Clinical Practice Guidelines that have been updated in each quarterly edition of Neighborhood News. Hard copies of the Clinical Practice Guidelines below are available upon request. Please call 1-401-459-6005 to request a copy.

• • ACCF/AHA Guideline for the Management of Heart Failure – Updated May 31, 2023
  • Adolescent Routine Preventive Services
  • Adult Diabetes Care 
  • Adult Routine Preventive Care 
  • Diagnosis and Management of Adult Coronary Artery Disease (CAD)  – Updated May 31, 2023
  • Diagnosis and Management of Asthma
  • Diagnosis and Management of Attention Deficit Hyperactivity Disorder (ADHD) in Primary Care for School Age Children and Adolescents
  • Diagnosis and Management of Chronic Obstructive Pulmonary Disease (COPD) – Updated May 31, 2023
  • Diagnosis and Management of Depressive Disorders in Adult Primary Care Patients – Updated May 31, 2023
  • Pediatric Routine Preventive Care – Updated May 31, 2023
  • Prenatal Care
  • Tobacco Cessation in Pregnancy
  • Tobacco Cessation for Adults
  • Use of Antibiotics for Pediatric Upper Respiratory Infections