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PROVIDER MANUAL - Sendero Health Plans

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<strong>Sendero</strong> Provider Manual Page 164 of 184<br />

Universal Authorization/Referral Form / <strong>Sendero</strong> Authorization and Referral Form<br />

Pregnancy Notification Form<br />

Specialist Acting as a PCP Request Form<br />

Medicaid “Your Texas Benefits ID” card<br />

Complaint Form<br />

Provider Information Form (PIF)<br />

Prior Authorization List – page 10<br />

Electronic Fund Transfer (EFT)<br />

Whole Person <strong>Health</strong> Support Referral Form<br />

<strong>Sendero</strong> STAR ID Card<br />

<strong>Sendero</strong> CHIP ID Card<br />

<strong>Sendero</strong> CHIP Perinate ID Card<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)

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