PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 68 of 184
Confidential information relating to a Member, including HIV/AIDS information will not be disclosed or
published without the prior written consent of the patient, parent, family, or legal guardian.
Any information that is no longer required confidential information is completely destroyed (i.e. shredded, etc.).
8.8 Focused Studies and Utilization Management reporting requirements
In conjunction with the QI Work Plan, Sendero Health Plans conducts focused studies to look at the quality of
care. Examples of focused studies would be those regarding diabetes care and treatment, and asthma care and
treatment.
The QI Work Plan is developed annually, and focused studies may be added at this review.
Other Utilization Management reports that are produced monthly and reviewed at the Provider Advisory
Subcommittee and the Behavioral Health Subcommittee meetings, as well as the QI Committee are as follows:
Review of admissions and admission/1,000 Members (Medical and Behavioral Health)
Review of bed days and bed days/1,000 Members (Medical and Behavioral Health)
Average length of stay for inpatient admissions (Medical and Behavioral Health)
ER utilization and health services utilization/1,000 Members
Denials and appeals
Other reports as needed to evaluate utilization of services by Membership
For information on any of the above reports, or to see one of these reports, contact the Health Services Director
for Sendero at 512-978-8176.
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)