Passport Health Plan’s mission is to improve the health and quality of life of our members. With this in mind, Passport Advantage has adopted the enclosed Clinical Practice Guidelines. The intent of the guidelines is to support your efforts in the care and education of our members and to reduce variation in diagnosis and treatment.

The Plan makes every effort to ensure that current scientific data and expert opinion is the basis for each guideline. Each guideline is evaluated as new data becomes available or at a minimum of every two years. Passport Advantage monitors provider compliance and member outcomes related to these clinical guidelines for quality improvement initiatives and recredentialing efforts.

These guidelines are intended to assist the practitioner in clinical decision-making and attempt to define clinical practices that apply to most patients in most circumstances.

The treating practitioner should make the ultimate decision regarding the care of a particular patient. If you would like a hard copy of the guidelines, please contact Utilization Management at (571) 385-3921.

Abdominal Aortic Aneurysm

Acute Bronchitis



Cancer Screening


Care of the Older Adult

Chronic Kidney Disease

Chronic Obstructive Pulmonary Disease (COPD)

Congestive Heart Failure (CHF)



Heart Failure


High Blood Pressure


Immunizations and Vaccinations

Low Back Pain

Opioid Use


Obesity and Overweight

Panic Disorder

Prenatal and Perinatal Care

Post Traumatic Stress Disorder (PTSD)


Sexually Transmitted Infections

Sickle Cell Disease

Substance Use Disorder



Last Modified: April 13, 2020