PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 94 of 184
ST 4.11 Texas Vaccines for Children (TVFC) Program
The Texas Vaccines for Children Program provides free vaccines to STAR/Medicaid children who are younger
than 19 years of age. TVFC automatically covers all vaccines recommended by the Advisory Committee on
Immunization Practices (ACIP) and approved by the Centers for Disease Control and Prevention (CDC). To
obtain free vaccine, the provider must enroll in the TVFC program through Department of State Health Services
(DSHS). Vaccine is ordered through regional state offices. A TVFC provider may not charge for the vaccine
itself, but is permitted to charge a reasonable administration fee. For more information, contact DSHS at 800-
252-9152 or 512-776-7284, or Network Management at the phone number listed below. See application form
in Appendix A of this manual.
ST 4.12 Texas Health Steps Lab and Testing Supplies
Specific laboratory tests required as part of the Texas Health Steps exam must be submitted to the Department
of State Health Services (DSHS) laboratory. Because these laboratory tests must be processed at the DSHS
Laboratory, they cannot be billed as separate claims on the same date of service as a medical checkup. The tests
that must be sent to the DSHS lab are Hemoglobin; Chlamydia, gonorrhea, and lead. The initial blood lead test
may be done by point-of-care testing in the providers office, and billed for reimbursement. The following tests
may be performed at a lab of the provider's choice: hyperlipidemia, type 2 diabetes, syphilis, or HIV.
All newly enrolled Texas Health Steps providers receive a startup package of forms and supplies. Included in
this startup package are blood specimen collection supplies. Additional supplies may be requested from DSHS
Laboratory Services via fax at 1-512-776-7672 or via their website at:
http://www.dshs.state.tx.us/lab/mrs_forms.shtm
ST 4.13 Texas Health Steps Dental Screenings
Pediatric (birth through age 20) dental services for STAR Members are covered under the Texas Health Steps
program. Routine dental exams and services are available beginning at age six (6) months and once every six
(6) months thereafter. These dental services are covered by the Texas Health Steps Dental Program through
HHSC. Members can self-refer to participating dentists in the Texas Health Steps Dental Program. Neither a
referral from the primary care provider nor authorization from Sendero is necessary for routine dental services.
ST 4.14 Dental-oral Evaluation and Fluoride Varnish (OEFV)
Dental-oral evaluation and fluoride varnish is covered by Sendero when provided in the PCP office for children
from 6 to 35 months of age. Oral evaluation and fluoride varnish (OEFV) in the medical home has been
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)