PROVIDER MANUAL - Sendero Health Plans

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)