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The Sendero Health Plans Quality Improvement Program is committed to continuously improving the quality of care and service for Sendero’s members and practitioners. Sendero is accredited by the National Committee of Quality Assurance (NCQA).
Sendero’s Quality Improvement Committee (QIC) reports to the Sendero Board of Directors and is responsible for implementation of the Quality Improvement Program. The QIC, in conjunction with four subcommittees (Provider Advisory, Compliance, Member Advisory, and Delegation Oversight), addresses all aspects of member, practitioner, and organizational quality.
This includes:
| ● | Implementation of programs that improve member health. |
| ● | Implementation of clinical practice guidelines, preventive health guidelines, medical necessity criteria, and medical, pharmaceutical and behavioral health policies. |
| ● | Evaluation of outsourced and delegated services – claims, vision, pharmacy, behavioral health services, customer service. |
| ● | Evaluation of the effectiveness of quality improvement interventions. |
| ● | Evaluating member and practitioner satisfaction. |
| ● | Maintaining an adequate practitioner and facility network. |
| ● | Monitoring internal and external audits and investigations for the purpose of identifying troublesome issues and deficient areas experienced by the company and implementing corrective and preventive action. |
| ● | Determining the appropriate strategy/approach to promote compliance with the program and detection of any potential violations, such as through hotlines and other fraud reporting mechanisms. |
| NOTICE DATE | NOTICE DETAILS |
|---|---|
| 01/29/25 | Notice to Physicians and Providers |
| NOTICE DATE | NOTICE DETAILS |
|---|---|
| 09/19/24 | Sendero TPA Transition Provider Notice |
| 06/05/24 | Taxonomy Requirement Provider Notice |
| 03/01/24 | Change Healthcare Provider Notice |
| 01/08/24 | Notice to Physicians and Providers |
| NOTICE DATE | NOTICE DETAILS |
|---|---|
| 11/10/23 | Provider and Practitioner 2023 Annual Reminder |
| 03/09/23 | Billing for Telehealth Therapy Services during the COVID-19 Response – Updated 3/9/2023 |
| 01/09/23 | Notice to Physicians and Providers |
| NOTICE DATE | NOTICE DETAILS |
|---|---|
| 12/29/21 | Provider and Practitioner 2021 Annual Reminder |
| 04/09/21 | Billing Update – National Drug Code Requirements – Effective 7/8/2021 |
| 04/09/21 | Prior Authorization Fax Forms – Effective 6/15/2021 |
| 01/25/21 | COVID-19 Response – Provider Guidance |
| 01/11/21 | Notice to Physicians and Providers |
Attention: This website is operated by Sendero Health Plans and is not the Health Insurance Marketplace® website at HealthCare.gov. This website does not display all Qualified Health Plans (QHPs) available through HealthCare.gov. To see all available QHP options, go to the Health Insurance Marketplace® website at HealthCare.gov. Also, you should visit the Health Insurance Marketplace® website at HealthCare.gov if you want to enroll members of your household in separate QHPs.
© Copyright Sendero Health Plans 2024. All Rights Reserved.
We are pleased to announce the creation of our affiliated insurance entity, Access to Care Health Plan by Sendero (ACHP), for all current members covered under the CHAP Expansion program. Sendero Health Plans will continue to be the insurance entity for all other members. No action is required for you to continue to render care to these CHAP Expansion members as their member ID will remain the same.
Please use your current Sendero provider portal login credentials to access the ACHP provider portal at https://providers.accesstocarehealth.com/.
You may access the Sendero Provider Portal at https://providers.senderohealth.com/ for all other Sendero members.
If you would like a list of assigned CHAP Expansion members on your panel that were moved to ACHP or have questions, please contact your provider relations representative by email at senderoproviders@senderohealth.com.
We look forward to continuing our partnership!
Skip the wait! Register now for the NEW Sendero Provider Portal to verify unlimited claims, authorizations, and eligibility 24/7
Please Note: Practice Administrators MUST be the ones to submit the registration request. All additional user accounts within the practice will be created and managed by the approved Practice Administrator.
