PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 30 of 184
Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery
and Reinvestment Act (collectively referred to as “HIPAA Requirements”) and other federal and state laws.
Forms Required by Sendero
Sendero does not require any health-plan-specific forms to be maintained in a provider’s medical records. The
forms used by each provider are determined solely by the provider, but must be sufficient to document all
treatment, counseling and education services to Members in an orderly, efficient and complete manner.
Sendero and HHSC Requests for Medical Records
Sendero and HHSC may from time to time request copies of medical records related to the treatment of Sendero
STAR or CHIP Members. Such requests for records will generally be for the purposes of (1) assessing or
evaluating aspects of the STAR and CHIP managed care programs, (2) responding to legislative or regulatory
inquiries or purposes, (3) responding to complaints or appeals filed by Members or providers, or (4) quality
improvement and/or utilization management functions. All providers are required to make available copies of
applicable records at no cost to Sendero or HHSC if the request comes from:
HHSC or other federal or state entities of competent jurisdiction.
Sendero as a direct result of a request for records from HHSC or other federal or state entities of
competent jurisdiction.
Sendero pursuant to the health plan’s utilization management pre-authorizations requested by the
provider.
Sendero in relation to a quality review.
Sendero or the State as a direct result of a Fraud, Waste, and Abuse investigation.
Confidentiality
All providers must maintain written policies and procedures with regard to maintaining the confidentiality of
medical records in a manner consistent with federal, state and local laws, rules and regulations, including the
Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for
Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act.
Sendero will maintain complete confidentiality with regard to medical records that may be requested from
providers. Sendero’s policies and procedures for confidentiality shall at all times be compliant with federal,
state and local laws, rules and regulations, including HIPAA and HITECH.
3.15 Changes in Provider Addresses or Contact Information or Opening of New
Office Locations
All network providers are required to notify Sendero and HHSC’s administrative services contractor in writing
of any changes in office address or in relevant contact information. Changes in office address should be
received by Sendero at least thirty (30) days prior to the change. This includes notifying Sendero when a
provider is leaving a group practice or joining another group practice or an employed provider is leaving a
group practice.
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)