PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 54 of 184
Other child-serving civic & religious organizations and consumer & advocacy groups.
March of Dimes
American Heart Association
American Lung Association
The Care Coordinator arranges social services, community services and other services as needed, including
DME.
For more information regarding Sendero’s WPHS case management program or for additional information on
the community agencies, contact Sendero’s Health Services Department at 1-855-297-9191.
6.10 Disease Management Programs
Disease Management Programs are largely retrospective oversight of high risk medical conditions. Disease
management is designed to prevent exacerbation of symptoms that might result in hospitalization. Disease
management is also designed to help Members with specific illnesses deal more effectively with their disease or
condition to as to improve their quality of life. Sendero’s Disease Management programs are a component of
the Whole Person Health Support (WPHS) program.
Currently, Sendero offers WPHS Programs for Attention Deficit Hyperactivity Disorders (and related
conditions), Asthma, Diabetes, and high risk pregnancy. These services are designed to increase patient
knowledge regarding their health, their disease process, nutrition, medication and importance of compliance
with the introduction of community resources available to them. If you encounter a Member that you feel would
benefit from one of these programs, please contact the Health Services Department by phone at 1-855-297-
9191, by completing a referral form (Appendix A) and faxing it to 1-512-275-2862 or by submitting a Referral
form on line at www. SenderoHealth.com. An RN Care Coordinator will be available to help in facilitating the
physician based treatment plan in a collaborative effort with the Member’s various healthcare providers to help
in improving or maintaining the wellbeing of the Member.
6.11 Practice Guidelines
Sendero Health Plans utilizes the American Academy of Pediatrics Practice Guidelines, as guidelines for care
for the pediatric Members. In addition, Sendero uses the asthma practice guidelines from the National Heart
Lung and Blood Institute. The immunization guidelines are followed as recommended by the American
Academy of Pediatrics as are the ADHD Practice Guidelines. Sendero’s guidelines for management of
Diabetes vary depending on the age of the individual and the pregnancy status. Questions regarding practice
guidelines may be directed to the Health Services Department. See Clinical and Preventative Care Guidelines
in Appendix C
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)