Thank you for your interest in American Specialty Health Group 
Decision-Making Guidelines  
The materials provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. ASH Group developed these guidelines with the involvement of actively practicing health care practitioners, internal clinicians and external clinical consultants, and ASH Group clinical peer review committees and are consistent with sound clinical principles and processes. These documents describe the manner in which ASH Group manages confidentiality, the qualifications of staff who make medical/clinical necessity decisions, how ASH Group has developed and adopted standards, conditions amenable to and contraindicated for treatment/services, expectations ASH Group has for documentation, timeliness of decision-making, and communication of decisions to the member and the treating practitioner. Current professionally recognized standards of practice, clinical principles, and clinical processes are the foundation of these guidelines. All references and resources are provided at the end of the documents. The references consist of medical texts, specialty-specific texts, peer reviewed research studies, and government publications. ASH Group evaluates and, when necessary, updates these guidelines at least annually. ASH Group uses these guidelines as the basis of a decision to approve, partially approve, delay, or not approve treatment/services in specified cases under evaluation/review and will disclose the applicable guideline to the practitioner and the member specific to the case as part of the member and practitioner response. 

ASH Group adherence to peer reviewed policies and guidelines are overseen by government regulatory agencies, national accrediting entities, health plan clients and appropriate ASH Group clinical peer review committees. 

Confidentiality of Medical Records
The confidentiality of member records is a high priority for ASH Group. ASH Group complies with the federal government's Health Insurance Portability and Accountability Act (HIPAA) requirements that contain standards for maintaining the privacy and confidentiality of patients' medical records. 

All staff having access to medical records signed the ASH Group confidentiality statement as a condition of employment. Staff members must follow the confidentiality policy at all times. All clinical peer review committees are structured to protect confidential information from inadvertent release and discovery. 

All medical records are stored within locked filing cabinets clearly marked "Confidential." Computer programs require multiple passwords to prevent unauthorized access or release of information. If medical records are to be transported between sites, they will be secured in a locked transportation device. 

Click the links below to access the Clinical Service Guidelines: 

Acupuncture
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 12: Medical Necessity Decision Assist Guideline for Rehabilitative Care
CPG 264: Acupuncture Services 
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023 

Chiropractic
CPG 1: X-ray Guidelines
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 12: Medical Necessity Decision Assist Guideline for Rehabilitative Care  
CPG 278: Chiropractic Services Medical Policy/Guideline
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023  

Massage Therapy
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 167: Therapeutic Massage Medical/Policy Guideline
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023 

Naturopathy
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 12: Medical Necessity Decision Assist Guideline for Rehabilitative Care
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023  

Nutrition Services
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management

Occupational Therapy
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 12: Medical Necessity Decision Assist Guideline for Rehabilitative Care
CPG 155: Occupational Therapy Medical Policy Guidelines
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023 

Physical Therapy
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 12: Medical Necessity Decision Assist Guideline for Rehabilitative Care
CPG 135: Physical Therapy Medical Policy Guideline
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023  

Speech Therapy
CPG 2: Practice Parameters and Review Criteria
CPG 3: Quality Patient Management
CPG 166: Speech-Language Pathology/Speech Therapy Guidelines
CPG 111: Patient Assessments: Medical Necessity Decision Assist Guideline for Evaluations, Re-evaluations and Consultations for Dates of Service Effective January 1, 2023  

To view and/or print pdf documents you will need Acrobat Reader installed.