PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 44 of 184
Contact Members who have missed appointments within 24 hours to reschedule appointments.
Make available to primary care providers behavioral health assessment instruments.
Communicate with the Member’s primary care provider, if OK with the Member, treatment plans and
progress to achieving treatment plan.
Refer the Member for needed lab and ancillary services if not available in the provider’s office.
5.14 7 Day Follow-up After Inpatient Behavioral Health Admission
Members must be scheduled for a seven (7) day follow-up appointment at time of discharge from an inpatient
Behavioral Health admission. These follow-up appointments are monitored by the Quality Improvement
Committee, as well as through Health and Human Services Commission (HHSC). Behavioral Health providers
need to ensure that these appointments are scheduled and kept.
Member’s appointments are followed by an RN Care Coordinator. Members who miss appointments are
attempted to be contacted to reschedule.
Members with a behavioral health diagnosis are also monitored for readmission to an inpatient mental health
facility. Results of these reports and focused studies are available to providers upon request.
5.15 DSM-IV Coding Requirements
Behavioral health documentation and referral requests should include DSM-IV multi-axial classifications.
Subsequently, behavioral health claims should be filed using the applicable and appropriate DSM-IV
diagnostic code to define the patient’s condition being treated. The DSM-IV is the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
5.16 Laboratory Services for Behavioral Health Providers
Behavioral Health providers should facilitate provision of in-office laboratory services for behavioral health
patients whenever possible, or at a location that is within close proximity to the Behavioral Health provider’s
office. Providers may refer Members to any network independent laboratory for needed laboratory services
with an appropriate laboratory order/prescription. Sendero does not require a referral for Members to have lab
work done.
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)