PROVIDER MANUAL - Sendero Health Plans
PROVIDER MANUAL - Sendero Health Plans
PROVIDER MANUAL - Sendero Health Plans
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<strong>Sendero</strong> Provider Manual Page 124 of 184<br />
Tuberculosis Services Provided by DSHS Approved Provider<br />
All confirmed or suspected cases of Tuberculosis must be referred to the Infectious Disease Control Unit of the<br />
DSHS using the forms and procedures for reporting TB adopted by DSHS. <strong>Sendero</strong> will assist providers in<br />
referring to the Local Tuberculosis Control <strong>Health</strong> Authority within 1 day of diagnosis for a contact<br />
investigation. The provider must document the referral to the local health authority in the Member’s medical<br />
records that may be reviewed by DSHS and the local authority. Providers should notify <strong>Sendero</strong> on any referral<br />
made to the local health authority.<br />
<strong>Sendero</strong> must coordinate with the local health authority to ensure that Members with confirmed or suspected TB<br />
have a contact investigation and receive directly observed therapy. <strong>Sendero</strong> will report any Member who is<br />
non-compliant, drug-resistant, or who is or may be posing a health threat to DSHS or the local authority.<br />
<strong>Sendero</strong> will cooperate with the local health authority in enforcing the control measures and quarantine<br />
procedures contained in Chapter 81 of the <strong>Health</strong> and Safety Code.<br />
DADS Hospice Services<br />
The Department of Aging and Disability Services (DADS) manages the Hospice Program through provider<br />
enrollment contracts with hospice agencies. Coverage of services follow the amount duration and scope of<br />
services specified in the Medicare Hospice Program. Hospice pays for services related to the treatment of the<br />
client’s terminal illness and for certain physician services (not the treatments). Hospice care includes medical<br />
and support services designed to keep clients comfortable and without pain during the last weeks and months<br />
before death.<br />
CH 2.7 Pharmacy/Navitus<br />
<strong>Sendero</strong> <strong>Health</strong> <strong>Plans</strong> has an arrangement with Navitus <strong>Health</strong> Solutions, a pharmacy benefit management<br />
company to administer pharmacy benefits for the STAR program. For questions related to the formulary,<br />
preferred drug list, prescription over-rides, quantity limits, brand necessity or formulary exceptions, please<br />
contact Navitus at 877-908-6023 or access the Navitus website through www.senderohealth.com.<br />
NAVITUS SUPPORTS E-PRESCRIBING FOR MEDICAID<br />
• Navitus provides point of care information available through Surescripts<br />
• Eligibility confirmation<br />
Daily updates to eligibility facilitator<br />
• Medication history<br />
• Formulary and PDL benefit confirmation<br />
• Formulary “alternative” drug list<br />
• Formulary lists will be updated no less frequently than weekly<br />
• Navitus expects pharmacies to have ability to accept e-prescriptions and facilitate refills with prescribers<br />
<strong>Sendero</strong> Customer Services 1-855-526-7388 Network Management 1-855-895-0475<br />
<strong>Health</strong> Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)