PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 38 of 184
5.0 – Behavioral Health Services
5.1 Definition of Behavioral Health
Behavioral health covered services are services for the treatment of mental, emotional or chemical dependency
disorders or any combination of these diagnoses. Substance abuse includes drug and alcohol abuse, and the
detoxification and withdrawal treatment that may be required.
5.2 Primary Care Provider Requirements for Behavioral Health
Primary care providers must screen, evaluate, refer, and/or treat any behavioral health problems and disorders
for Sendero. The primary care provider may provide behavioral health services within the scope of its practice.
Timely and appropriate patient assessment and referral are essential components for the treatment of behavioral
health issues.
Sendero has a comprehensive network of behavioral health service providers for the treatment of mental health
and drug and alcohol abuse issues.
5.3 Sendero Behavioral Health Services Program
Behavioral Health Services are covered services for the treatment of mental emotional disorders and for
chemical dependency disorders for both STAR (under the age of 21) and CHIP Members of Sendero. STAR
Members over age 21 also have treatment for chemical dependency disorders as a covered benefit.
Primary care providers are responsible for coordinating Members’ physical and behavioral health care,
including making referrals to in-network Behavioral Health providers when necessary. In addition, primary
care providers must adhere to screening and evaluation procedures for the detection and treatment of, or referral
for any known or suspected behavioral health problems or disorders. Providers should follow generally
accepted clinical practice guidelines for screening and evaluation procedures, as published through appropriate
professional societies and governmental agencies, such as the National Institute of Health. Primary care
providers may provide behavioral health related services within the scope of their practice.
All services which require pre-authorization related to behavioral health must be coordinated through
Sendero.
For mental health services not covered by STAR/Medicaid, the Member must access local resources. Please
refer the member to Sendero’s RN Care Coordinators in Health Services at 1-855-297-9191 to help in
locating these resources.
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)