PROVIDER MANUAL - Sendero Health Plans

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Sendero Provider Manual Page 28 of 184 provide an application to the health plan, along with information identifying the medical director who provides oversight ensure that the medical director providing oversight completes an application and forwards it to Sendero, so that he/she may complete the credentialing process be credentialed by the health plan follow all regulations required by the State of Texas regarding collaborating physician oversight have the collaborating physician sign the Sendero form understanding requirements of oversight of the mid-level practitioner Mid-level practitioners may be primary care providers, if they meet all the requirements as directed by their Texas licensing board to be an independent practitioner. Questions regarding the practitioner services may be directed to the Network Management number below. 3.13 Marketing Guidelines Affecting Providers All health plan marketing activities targeting STAR and CHIP Members must be pre-approved by Health and Human Services Commission (HHSC). This includes marketing activities by providers that are targeted at STAR and CHIP enrollees. The following guidelines and prohibitions apply to marketing activities of STAR and CHIP providers. Permitted Activities 1. Providers may inform patients of all health plans in which they participate. 2. Providers may inform their patients of the benefits, services, and specialty care services offered through the health plans in which they participate. 3. At the patients’ request, providers may give patients the information necessary to contact a particular health plan. 4. Providers may distribute or display written health educational materials (see definition below) or health related posters (no larger than 16” by 24”) developed by the health plan so long as they do so for ALL health plans in which the provider participates. These materials may have the health plan’s name, logo and phone number on them. 5. Providers may display plan stickers (no larger than 5” by 7”) indicating they participate with a particular Health Plan so long as they display Prohibited Activities 1. Providers are not allowed to stock, reproduce or handle program enrollment forms. As stated in #6 under permitted activities. Providers can distribute application forms to uninsured children, just not the enrollment form. 2. Providers CANNOT help people in filling out the program enrollment forms or in making a decision on selecting a health plan. 3. Non-health related materials or banners that are for a specific health plan (even if the provider is contracted with the health plan) are NOT allowed in provider offices. 4. Providers may not make false, misleading or inaccurate statements related to services, benefits, providers, or potential providers of any health plan. 5. Provider may not recommend one health 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 29 of 184 Permitted Activities stickers by ALL contracted MCOs. These stickers can not indicate anything more than that the “health plan is accepted or welcome”. Stickers MUST display the applicable STAR and/or CHIP logo. plan over another. Prohibited Activities 6. Providers may distribute application booklets to families of uninsured children and may help with completing the application. 7. Providers may direct patients to enroll in STAR or CHIP programs by calling the state Administrative Service Contractor. DEFINITION: Health Education Materials are materials produced by the health plan or a third party that contains information related to health (i.e. immunization, diabetes, heart disease, birth control, prenatal care, Texas Health Steps screenings, nutrition, health education classes, etc.) and DOES NOT include announcements of health fairs, materials that are specific to a given health plan, or materials that are specific to STAR/Medicaid or CHIP programs. 3.14 Medical Records Maintenance of Records All Sendero providers are required to maintain a written or electronic medical record that complies with the standards of the health care industry and with the requirements of applicable federal, state and local laws, rules and regulations. Records must be: Individual to each patient A complete and accurate representation of all medical services, counseling and patient education provided by the provider including ancillary services Maintained in an orderly and legible fashion Kept secured to ensure the maintenance of confidentiality and be accessible only to practice employees and eligible persons as permitted by law Maintained pursuant to procedures of confidentiality that comply with the Health Insurance Portability and Accountability Act (HIPAA) Made available to the patient according to the written policies and procedures Made available to appropriate parties allowed to view such records pursuant to HIPAA and other relative federal, state and local laws, rules and regulations Electronic Medical Records Providers, who use electronic medical recording keeping within their office, must have a system that conforms to all the requirements of the Health Insurance Portability and Accountability Act (HIPAA) and the Health 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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