PROVIDER MANUAL - Sendero Health Plans

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Sendero Provider Manual Page 6 of 184 CP 4.1 Introduction ............................................................................................................................................. 157 CP 4.2 What is a Complaint? .............................................................................................................................. 157 CP 4.3 What is an Appeal? ................................................................................................................................. 157 CP 4.4 CHIP Perinatal: Complaints & Appeals.................................................................................................. 157 CP5 – CHIP PERINATAL MEMBER RIGHTS AND RESPONSIBILITIES ................. 161 CP 5.1 Member Rights ........................................................................................................................................ 161 CP 5.2 Member Responsibilities......................................................................................................................... 161 APPENDIX A ........................................................................................................................... 163 Universal Authorization/Referral Form/Sendero Authorization & Referral Form ............................................. 165 Pregnancy Notification Form .............................................................................................................................. 169 Specialist Acting as a PCP Request Form .......................................................................................................... 170 Medicaid “Your Texas Benefits ID” Card .......................................................................................................... 171 Complaint FormProvider Information Form (PIF) ............................................................................................. 172 Electronic Fund Transfer (EFT) .......................................................................................................................... 175 Sendero STAR ID card ....................................................................................................................................... 177 Sendero CHIP ID card ........................................................................................................................................ 178 Sendero CHIP Perinate ID card .......................................................................................................................... 179 APPENDIX B ............................................................................................................................ 180 Provider Complaints and Appeals ...................................................................................................................... 181 APPENDIX C ........................................................................................................................... 182 Preventive Care Guidelines List ......................................................................................................................... 183 Clinical Practice Guidelines List ........................................................................................................................ 184 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 7 of 184 1.0 – Quick Reference Guide 1.1 Sendero Health Plans – Quick Reference Guide Address Physical and Mailing Address 2028 East Ben White Blvd. Suite 510 Austin TX 78741 Department Phone Numbers Member Services Medicaid STAR CHIP 1-855-526-7388 1-855-526-7388 Claims Medicaid and CHIP 1-855-526-7388 Network Management 1-855-895-0475 Fax 512-901-9704 Internet Website www.senderohealth.com Health Services Management Medical 1-855-895-0475 Fax 512-275-2862 Behavioral Health HOT LINE 1-888-287-5403 (CHIP) 1-888-287-5402 (STAR) Self-Referrals PCP referral is not required when a participating network specialist is utilized for: In-network or Out-of-network Self-referral Out-of-area emergency services Family planning services Texas Health Steps medical case management services for STAR Members Early Childhood Intervention (ECI) case management services Children and Pregnant Women (CPW) case management services School Health and Related Services (SHARS) program services Department of Assistive and Rehabilitative (DARS) case management services for STAR Members Department of State Health Services (DSHS) case management services for STAR Members Department of Aging and Disability Services (DADS) case management services for STAR Members In-network-only Self-referral for Covered Services – Paid by Sendero Behavioral health services Emergency room care Obstetric services Well-woman gynecological services Vision care, including covered eye glasses 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)
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PROVIDER MANUAL - Sendero Health Plans

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