PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 81 of 184
Take-home and self-administered drugs except as provided under the vendor drug or family planning
pharmacy services.
Tattooing (commercial or decorative only).
Telephone calls with clients or pharmacies (except as allowed for case management).
Thermogram.
Treatment of flatfoot conditions for solely cosmetic purposes and the prescription of supportive devices
(including special shoes), the treatment of subluxations of the foot.
Spell of Illness Limitation Removed
In the traditional Medicaid program, the Spell of Illness Limitation is defined as thirty (30) days of inpatient
hospital care, which may accrue intermittently or consecutively. After thirty (30) days of inpatient care is
provided, reimbursement for additional inpatient care is not considered until the patient has been out of an acute
facility for sixty (60) consecutive days. This limitation does NOT apply to Sendero Health Plans’ STAR
Members.
Annual Limit Does NOT Apply
$200,000 annual limit on inpatient services does not apply for STAR Members.
Adult Annual Examination
An annual adult physical exam is an additional benefit for STAR Members 21 years and older. The annual
adult well exam may be received in addition to the Member’s annual GYN visit for females. The Member does
not need a referral from the primary care provider for the annual GYN visit.
Unlimited Medically Necessary Prescription Drugs for Adults
STAR Members who are 21 years of age or older receive unlimited medically necessary prescription drugs.
The elimination of the three (3) prescription limit per month for adult clients enrolled in STAR allow the
provider greater flexibility in treating and managing a Member’s healthcare needs.
ST 2.2 Sendero’s Value Added Services
In addition to the standard benefits for STAR Members, Sendero Health Plans provides certain Value Added
Services including:
Value Added Service
Nurse Line
Value-added Vision Services
STAR Program
SERVICE: Sendero has available to STAR Members a 24 hour a day,
365 days per year nurse advice line. Members can access the nurse line
via a toll-free telephone number. The nurse line can assist Members
with various health-related questions, as well as provide guidance as to
when to access emergency facilities.
SERVICE: $100 above the Medicaid allowable per 24 month period
for corrective eyewear.
LIMITATION: The benefit is limited only as it applies to frequency
and Members who are 2 years or older.
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)