PROVIDER MANUAL - Sendero Health Plans
PROVIDER MANUAL - Sendero Health Plans
PROVIDER MANUAL - Sendero Health Plans
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<strong>Sendero</strong> Provider Manual Page 62 of 184<br />
Member Billing Situations<br />
SERVICE<br />
PLAN<br />
PAYS<br />
NOTHING<br />
PLAN PAYS<br />
CONTRACTE<br />
D RATE<br />
PLAN PAYS<br />
USUAL &<br />
CUSTOMARY<br />
<strong>PROVIDER</strong> CAN BILL<br />
MEMBER if an Advance<br />
Beneficiary Notice and<br />
Private Pay Form was<br />
Executed Prior to<br />
Rendering the Services<br />
<strong>PROVIDER</strong><br />
CANNOT<br />
BALANCE<br />
BILL<br />
MEMBER<br />
IN NETWORK<br />
Authorized <br />
Not<br />
Authorized<br />
<br />
OUT-OF-NETWORK<br />
Authorized <br />
Not<br />
Authorized<br />
<br />
EMERGENCY CARE<br />
In Network <br />
Out-Of-<br />
Network<br />
Non-<br />
Covered<br />
Services<br />
<br />
<br />
<br />
<br />
See “STAR – B –<br />
STAR/Medicaid Covered<br />
Services” or “CHIP – B –<br />
Covered Services” in this<br />
manual<br />
Co-pay Amounts for STAR/Medicaid Members: There are no co-payments for STAR/Medicaid Members.<br />
Co-pay Amounts for CHIP Members: Providers may collect co-pay amounts from CHIP Members as outlined<br />
below or on the Member’s CHIP identification card.<br />
Co-pay Amounts for CHIP Perinatal Members: There are no co-payments for CHIP Perinatal Members.<br />
<br />
<br />
7.21 Collecting from or Billing CHIP Members for Co-pay Amounts<br />
Some CHIP Members have co-pay amounts for certain services. The Members’ <strong>Sendero</strong> identification card will<br />
indicate the co-pay amounts for these specific services. Only valid co-pay amounts can be collected from CHIP<br />
Members.<br />
For a list of when a co-pay applies, refer to Chapter 4.0 of this Provider Manual.<br />
<strong>Sendero</strong> Customer Services 1-855-526-7388 Network Management 1-855-895-0475<br />
<strong>Health</strong> Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)