PROVIDER MANUAL - Sendero Health Plans

More documents

Recommendations

Info

Sendero Provider Manual Page 64 of 184 ATTN: Sendero Appeals P.O. Box 3869 Corpus Christi, TX 78463 7.25 Claims & Appeals Questions For questions regarding claims, please contact Sendero Customer Services at the phone number at the bottom of this page. 7.26 Electronic Funds Transfer (EFT) For your convenience, Sendero is pleased to offer Electronic Funds Transfer (EFT) as a method of receipt to claims payment. You may authorize Sendero to present credit entries into a bank account with minimal paperwork. A copy of the EFT form can be obtained in this Provider Manual or on the Sendero website at www.senderohealth.com or by calling your Provider Relations Representative. (See Appendix A for a copy of this form.) 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 65 of 184 8.0 – Sendero Quality Program 8.1 Sendero’s Quality Improvement Program (QIP) Sendero Health Plans’ Quality Improvement Program actively monitors and evaluates services provided to health plan enrollees. The program is designed to assist Members of Sendero Health Plans in receiving appropriate, timely, and quality services rendered in settings suitable to their individual needs while promoting primary preventive care in an effort to achieve optimal wellness. Authority for the program is received from the Sendero Health Plans’ Board of Directors. The Board of Directors receives annual reports concerning the operation of the program from the Quality Improvement Committee. Annually, a Quality Improvement (QI) Work Plan is developed to identify areas to monitor for the coming year. The QI Work Plan includes monitoring and evaluating the structure, process, and outcomes of the health plans delivery system. The Sendero Health Plans’ Board of Directors approves the QI Work Plan. 8.2 Sendero’s Provider Quality Measures The Annual QI Work Plan includes ongoing specific quality measures that directly involve providers. Other areas may be added throughout the year. These measures include, but are not limited to, reviews of: Accessibility and Availability of Providers. Complaints from Members and Providers Emergency Room utilization Quality of Care Focused Studies (Diabetes and Asthma) MRSA claims Texas Health Steps and Well-Child exams Cervical Cancer Screening Perinatal Care Member and Provider Satisfaction surveys Review of Denials and Appeals Continuity of Care reviews Medical and Behavioral Utilization Statistics Sendero Health Plans monitors after hours accessibility and appointment availability of providers twice a year. Providers are expected to follow the standards as defined “3.0 – Guidelines for Providers” in this Provider Manual. 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)
Page 1 and 2:
Sendero Provider Manual Page 1 of 1
Page 3 and 4:
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Sendero Provider Manual Page 11 of
Page 13 and 14: Sendero Provider Manual Page 13 of
Page 63: Sendero Provider Manual Page 63 of
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
show all

PROVIDER MANUAL - Sendero Health Plans

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?