PROVIDER MANUAL - Sendero Health Plans

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Sendero Provider Manual Page 12 of 184 STAR/Medicaid Managed Care Sendero Health Plans is contracted with HHSC as one of the HMO’s in the Travis Service Delivery Area (SDA). The STAR program provides a full range of Medicaid health services to newborn, pregnant women, children, and adults. Children’s Health Insurance Program Sendero Health Plans will begin serving CHIP recipients in March 2012. The program is designed for families who earn too much money to qualify for Medicaid yet cannot afford to buy private insurance for their children. CHIP provides eligible children (up to age 19) with coverage for treatment for a full range of health services including regular checkups, immunizations, prescription drugs, lab tests, X-rays, hospital visits, and more. Sendero Health Plans is one of the HMO choices for a child with CHIP coverage in the Travis Service Delivery Area (SDA). CHIP Perinatal Sendero Health Plans will begin serving CHIP Perinatal members in March 2012. CHIP Perinatal provides care to unborn children of pregnant women with household income up to 200% of the federal poverty level (FPL) and who are not eligible for Medicaid. Once born, the child will receive benefits that are similar to the traditional CHIP benefits for the duration of the 12-month coverage period. Sendero Health Plans is one of the HMO choices for an unborn child / newborn with CHIP Perinatal coverage in the Travis Service Delivery Area (SDA). Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475 Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)
Sendero Provider Manual Page 13 of 184 2.2 Sendero’s Philosophy of Business Sendero has established a working collaboration with its provider network; one that strives to improve access to care, efficiency in care and continued quality of care for our Members. We endeavor to make this approach gain Sendero the respect and cooperation of the provider community throughout the Travis Service Delivery Area (SDA). We encourage providers to be very involved, through the Medical Director and the Health Services Department, in review of clinical guidelines and in creating programs to benefit the Service Delivery Area. These strong and mutually beneficial relationships ensure excellence in the delivery of health care services to Sendero Members and the community at large. 2.3 Sendero’s Program Objectives The program objectives of Sendero focus on: comprehensive well-child care, including childhood immunization case management opportunities to coordinate care ADHD, asthma and diabetes disease management programs to collaboratively improve control of these chronic conditions with affected Members early and continuous prenatal care for pregnant Members geared to improve birth outcomes effective behavioral health care services, including medication management outreach and care coordination for children with special health care needs 2.4 Sendero’s Material Subcontractors / Other Key Vendors Sendero administers its own programs, manages all quality improvement processes, ensures compliance with the State contract, and oversees the development of its comprehensive network of providers and facilities. Sendero contracts with an Administrative Services Organization (ASO) to provide operational services and information management processes along with other subcontractor organizations to provide services. Subcontractors include: Corporate Printing – providing all non-marketing printed material for Providers and Members Navitus Health Solutions, LLC – to meet pharmacy needs for CHIP and STAR Members. Valence Health – providing Claims processing and adjudication, and Customer Services Westport Insurance Corporation – providing Reinsurance services for Sendero Key Vendors include: Allied Management Group - providing Fraud and Abuse and Special Investigative Unit Avail – providing 24 hour Behavioral health hotline services. Bratton Law Firm – providing Subrogation Management services for Sendero Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475 Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)
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