PROVIDER MANUAL - Sendero Health Plans

More documents

Recommendations

Info

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)
Sendero Provider Manual Page 39 of 184 A list of local resources for behavioral health care alternatives outside of network providers is available through the following public resources: o The local Department of Health Services offices o The local Public Library o The Finding Help in Texas website-- www.211texas.org/211 – or toll free at 2-1-1. Community Mental Health Centers will accept patients with the primary diagnosis of schizophrenia, bi-polar or severe major depression, along with many other behavioral health diagnoses (ADD, ADHD, post-traumatic stress disorder, etc.). The following CMHCs serve Members in the Travis Service Delivery Area as follows: Austin Travis County Integral Care (formerly Austin Travis County MHMR Center) 1430 Collier St. Austin, TX 78704 Crisis Phone: 512-472-4357 Main Phone: 512-447-4141 Website: http://www.integralcare.org/ Counties Served: Travis Bluebonnet Trails Community MHMR Center 1009 Georgetown St. Round Rock, TX 78664 Crisis Phone: 800-841-1255 Main Phone: 512-255-1720 Website: http://www.bluebonnetmhmr.org/ Counties Served: Bastrop, Burnet, Caldwell, Fayette, Lee, and Williamson Hill Country Community MHMR Center 819 Water St., Ste. 300 Kerrville, TX 78028 Crisis Phone: 877-466-0660 Main Phone: 830-792-3300 Website: http://www.hillcountry.org/ Counties Served: Hays 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)
Page 1 and 2: Sendero Provider Manual Page 1 of 1
Page 11 and 12: Sendero Provider Manual Page 11 of
Page 37: Sendero Provider Manual Page 37 of
Page 89 and 90:
Sendero Provider Manual Page 89 of
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
show all

PROVIDER MANUAL - Sendero Health Plans

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?