PROVIDER MANUAL - Sendero Health Plans

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Sendero Provider Manual Page 18 of 184 are implemented, enforced, and describe the duties of all such individuals in accordance with statutory requirements for licensure, delegation, collaboration, and supervision as appropriate. Interpreter/Translation Services If you have a Member who needs help with special language services including interpreters, please call Customer Services. Sendero is contracted with Language Services Associates, who can assist you with interpretation services in your office. Call 1-866-482-8230 CODE 31091 and provide the customer service representative at Language Services Associates with the following: Language needed Member Sendero ID number Physician’s first and last name If you need an interpreter in the office when the Member sees you, please call, or have the Member call the Health Services department at least 48 hours before his/her appointment to schedule these services. You can also contact Relay Texas for telephone interpreter service for deaf or hard of hearing Sendero Members by dialing 711 and requesting to communicate with the Member. This service is available for Texans 24 hours a day, 365 days a year. There are no restrictions imposed on Relay Texas calls. 3.2 Who Can Be a Primary Care Provider? The following Sendero network provider types are eligible to serve as a primary care provider for STAR and CHIP Members: Pediatrician Family or General Practitioner Internist Rural Health Clinic (RHC) Federally Qualified Health Center (FQHC) Pediatric and Family Nurse Practitioners (PNP and FNP) Physician Assistants (PA) (under the supervision of a licensed practitioner) Obstetricians/gynecologists electing to be a Primary Care Provider Specialists, as approved by Sendero, willing to provide a medical home for specific Members with certain special health care needs or illnesses (see below) 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 19 of 184 3.3 OB/GYN Physician Sendero Members are allowed to self-refer to a network OB/GYN for any of the well-woman services stated below. This information is clearly communicated to the Members in the Member Handbook. No referral is required. Sendero allows you to pick an OB/GYN but this doctor must be from within the same network as your Primary Care Provider. ATTENTION FEMALE MEMBERS: You have the right to pick an OB/GYN without a referral from your Primary Care Provider. An OB/GYN can give you: One well-woman check-up each year Care related to pregnancy Care for any female medical condition Referral to specialist doctor within the network The female STAR or CHIP Member may designate the OB/GYN physician as her primary care provider. The OB/GYN physician must agree to being designated as the primary care provider and must agree to abide by all the primary care provider requirements, including but not limited to, being available 24 hours a day, seven (7) days a week. A referral from an existing primary care provider is not required for the female Member to designate an OB/GYN physician as a primary care provider. The OB/GYN physician must be part of the Sendero network of providers, because Sendero limits a Member’s selection of OB/GYN providers to innetwork providers. OB/GYN Responsibilities Once the obstetrical services provider diagnoses a Member’s pregnancy, the provider must notify Sendero Health Plans by using one of the following methods: completing the Sendero Pregnancy Notification Form (see Appendix A) completing a similar form containing the required information Notifying WPHS Case Management with the required information by calling 1-855-297-9191 or faxing Sendero at 512-275-2862. Providers are not required to use the Sendero Pregnancy Notification form itself, but may provide the same information via some other form, such as the American College of Obstetricians and Gynecologists (ACOG) or Hollister high risk forms or other similar forms. If a health condition develops or is discovered during the selfreferral episode of care that is likely to have an ongoing effect on the Member’s health and/or the Member’s relationship with or care from her primary care provider, the OB/GYN provider should provide a written report to the Member’s primary care provider unless the Member specifically requests that no such report be made. 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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PROVIDER MANUAL - Sendero Health Plans

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