PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 41 of 184
The following services are available to all STAR Members under the age of 21 years of age and to all CHIP
members:
Inpatient Mental Health Services
Outpatient Mental Health Services
Behavioral Health Inpatient Facilities must ensure that a seven (7) day follow-up appointment is made prior to
Member discharge from an inpatient stay.
For details about behavioral health covered benefits see “ST2 STAR/Medicaid Covered Services” or “CH2
Covered Services” in this manual.
5.6 Referral Authorizations for Behavioral Health Services
Sendero Members do not require referrals from their primary care providers for initial evaluation or follow-up
behavioral health treatment from an in network Behavioral Health provider. Pre-authorization is only required
for Psychological testing. . Primary care providers may provide Behavioral Health Services for Members, if it
is within the scope of his/her practice. .
5.7 Pre-authorization
Prior authorization is required for > 20 visits for outpatient treatments. Prior authorization of an emergent,
elective or scheduled admission is NOT required. The Behavioral Health Hotline is available for members 24/7
by calling Avail Solutions at 1-888-287-5402 for STAR and 1-888-287-5403 for CHIP. Psychological testing
requires pre-authorization. This may be obtained by the provider faxing a prior-authorization for psychological
testing form to the Health Services Department for approval prior to testing being initiated. (See the fax
number at the bottom of this page.)
5.8 Triage and Initial Assessment
Sendero has clinicians available 24 hours a day, seven days a week to help Members with referrals to
practitioners, facilities, urgent or emergent care and crisis calls. Sendero’s RN Care Coordinators or a Crisis
Intervention Specialist (through the Behavioral Health Crisis Hotline) helps Members with clinical
determinations, urgent and emergent care, crisis calls and referrals to facilities. The goal of the referral and
triage process is to provide accurate information and referrals to appropriate providers. During the workday,
call Sendero’s RN Care Coordinators at 1-855-297-9191 for assistance. After hours, on weekends and on
holidays, a Crisis Intervention Specialist can be reached at:
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)