PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 70 of 184
Evidence of current state licensure for the Nurse Practitioner (Advance Practice Nurse) and
Physician Assistant;
Evidence of protocols or orders in place to provide medical authority and prescriptive authority;
Verification that these protocols or orders are signed by the Medical Director and reviewed annually;
Evidence that the Medical Director has visited at least once every ten (10) days; and
Evidence that the Nurse Practitioner or Physician Assistant has given a daily report to the Medical
Director if there are complications.
The physician and office are notified of the results of the review by registered letter, with any deficiencies
identified. Physician office site visits that do not achieve a score on the assessment of 85% compliance or
higher will be written as failing the visit score. The physician’s office will be made aware of the deficiency,
and will be given a time frame to make corrections. Another site visit will be conducted within six months from
the date of the deficient visit. The provider’s office will be given feedback of the site visit findings as they
work towards correcting areas of non-compliance.
9.3 Required Office Policies & Procedures
Sendero Health Plans requires that network providers have Policies & Procedures in place for:
Advance Directives: Sendero requests that information on Advance Directives be provided to any
Sendero Member 18 years of age or older.
Oversight of Mid-Level Practitioners: Sendero requires that policies defining the role of the Mid-
Level Practitioner in providing health care within their scope of practice be in place at the provider’s
office.
Medical Record Confidentiality: Sendero requests that the provider’s office implement and maintain a
policy which acts to ensure the confidentiality of patient information as required by the Health Insurance
Portability and Accountability Act of 1996 (HIPAA).
Release of Records: The provider’s office must have a policy in place directing its staff to follow a
specific process that is HIPAA compliant for release of records.
Informed Consent and ID: A written policy and procedure must be in place for confirming the
identification of a member and obtaining consent for treatment prior to rendering services.
Maintenance of Medical Records: The office should have a written policy regarding the safeguard
against loss, destruction, or unauthorized use of any medical records.
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)