PROVIDER MANUAL - Sendero Health Plans

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Sendero Provider Manual Page 86 of 184 Tuberculosis Services Provided by DSHS Approved Provider All confirmed or suspected cases of Tuberculosis must be referred to the Infectious Disease Control Unit of the DSHS using the forms and procedures for reporting TB adopted by DSHS. Sendero will assist providers in referring to the Local Tuberculosis Control Health Authority within 1 day of diagnosis for a contact investigation. The provider must document the referral to the local health authority in the Member’s medical records that may be reviewed by DSHS and the local authority. Providers should notify Sendero on any referral made to the local health authority. Sendero must coordinate with the local health authority to ensure that Members with confirmed or suspected TB have a contact investigation and receive directly observed therapy. Sendero will report any Member who is non-compliant, drug-resistant, or who is or may be posing a health threat to DSHS or the local authority. Sendero will cooperate with the local health authority in enforcing the control measures and quarantine procedures contained in Chapter 81 of the Health and Safety Code. DADS Hospice Services The Department of Aging and Disability Services (DADS) manages the Hospice Program through provider enrollment contracts with hospice agencies. Coverage of services follow the amount duration and scope of services specified in the Medicare Hospice Program. Hospice pays for services related to the treatment of the client’s terminal illness and for certain physician services (not the treatments). Hospice care includes medical and support services designed to keep clients comfortable and without pain during the last weeks and months before death. Texas Health Steps Case Management Texas Health Steps Case Management for Children & Pregnant Women provides services to children with a health condition/health risk, birth through 20 years of age and to high-risk pregnant women of all ages, in order to help them gain access to medical, social, educational and other health-related services. The Texas Health Steps phone number is 1-877-847-8377 (877-THSTEPS). Providers can call in a request, complete the referral form and fax it to Texas Health Steps SSU at 512-533-3867, or contact a regional contracted provider. Sendero Health Plans Whole Person Health Support program can also help these members attain the care they need. If you or the member or parent would prefer, you can contact a contracted Case Management vendor in our service area. A current list of these licensed and contracted vendors can be found at www.dshs.state.tx.us/caseman/hsr7.shtm. ST 2.6 Pharmacy/Navitus Sendero Health Plans has an arrangement with Navitus Health Solutions, a pharmacy benefit management company to administer pharmacy benefits for the STAR program. For questions related to the formulary, “How to” find a list of covered drugs, “How to” find a preferred drug list, the process for requesting a prior authorization (PA), prescription over-rides, quantity limits, brand necessity or formulary exceptions, please contact Navitus at 877-908-6023 or access the Navitus website through www.senderohealth.com. NAVITUS SUPPORTS E-PRESCRIBING FOR MEDICAID 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 87 of 184 D ME • Navitus provides point of care information available through Surescripts • Eligibility confirmation Daily updates to eligibility facilitator • Medication history • Formulary and PDL benefit confirmation • Formulary “alternative” drug list • Formulary lists will be updated no less frequently than weekly • Navitus expects pharmacies to have ability to accept e-prescriptions and facilitate refills with prescribers Navitus will encourage Texas Medicaid Network Pharmacies to become Medicaid-enrolled durable medical equipment (DME) providers with the MCO’s in their Service Areas. ST 2.7 OB/GYN Sendero allows you to pick an OB/GYN provider but this doctor must be in-network. ATTENTION FEMALE MEMBERS You have the right to pick an OB/GYN without a referral from your Primary Care Provider. An OB/GYN can give you: One well-woman checkup each year Care related to pregnancy Care for any female medical condition Referral to a specialist doctor within the network 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)
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PROVIDER MANUAL - Sendero Health Plans

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