PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 60 of 184
7.16 Billing for Deliveries and Newborn Services
Sendero requires separate claim forms for mothers and babies. Every effort should be made to bill claims with
the appropriate Medicaid ID Number. However, since there may be a delay in obtaining a Medicaid number for
a newborn, Sendero accepts billing for newborns using the mother’s Sendero ID # affixed with an “A” at the
end. If the mother gave birth to multiple newborns, sequentially use “A”, “B”, “C”, etc. and submit a separate
claim for each newborn.
EXAMPLE 1: Mother delivers a single live child.
Mother = 12345678
Newborn = 12345678A
EXAMPLE 2: Mother delivers twins.
Mother = 87654321
Newborn 1 = 87654321A
Newborn 2 = 87654321B
Claim forms that reflect combined charges for both a mother and a newborn will be rejected or will be subject
to denial.
7.17 Billing for Outpatient Surgery Services
A limited number of Outpatient Surgeries require pre-authorization which are outlined in Appendix A. To
ensure payment for any of these surgeries, include the authorization number on your submitted claim. An
authorization may be obtained by submitting a request via our web site at www.senderohealth.com, by faxing a
request to the Health Services Department at 512-275-2862 or by contacting the Health Services Department at
the phone number below.
Physician Claims: Submit the claim on the standard CMS-1500 or using the acceptable ANSI-837 professional
electronic format. The applicable CPT-coded surgical procedure code(s) must be identified.
Facility Claims: Claims from hospitals, ambulatory surgery centers or other facilities where outpatient surgery
may be performed, must be submitted on the CMS-1450 (UB04) form of using the acceptable ANSI-837
institutional electronic format, with the applicable ICD9 surgical procedures code(s), date of the surgery,
itemized charges, and associated CPT/HCPCS procedure codes.
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)