1-844-800-4693 Mon – Fri 8AM – 8PM, Sat 9AM – 6PM

Providers

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.

Thank you for your interest in becoming an in-network provider for Sendero Health Plans.

For more information on joining our provider network, please email us at providers@senderohealth.com or click here to download a provider interest form.

If you have any questions about joining our network, please call our Network Management team at 1-855-895-0475.

Post DatePost Details
10/31/22Provider Manual and Preauthorization List Update Notice – Effective 1/1/2023
09/30/22Provider Manual Update Notice – Effective 10/1/2022
09/20/22Billing for Telehealth Therapy Services during the COVID-19 Response
01/31/22Reminder – Billing Update – National Drug Code Requirements – Effective 7/8/2021
01/10/22Notice to Physicians and Providers
12/29/21Provider and Practitioner 2021 Annual Reminder
04/09/21Billing Update – National Drug Code Requirements – Effective 7/8/2021
04/09/21Prior Authorization Fax Forms – Effective 6/15/2021
01/25/21COVID-19 Response – Provider Guidance
01/11/21Notice to Physicians and Providers
10/30/20Provider Manual and Prior Authorization List Update Notice – Effective 1/1/2021
10/01/202021 SelectCare plan update
07/10/20Education on Prior Authorization Request Submission
05/28/20Applied Behavior Analysis Billing Update Notice – Effective 8/26/2020
05/28/20Prior Authorization List Update Notice – Effective 7/27/2020
02/14/20Prior Authorization List Update Notice – Effective 4/15/2020
02/10/20Prior Authorization List Update Notice – Effective 3/1/2020
02/10/20Home Health Services Billing Update Notice – Effective 3/1/2020
01/29/20Provider Manual Update Notice – Effective 2/1/2020
01/13/20Notice to Physicians and Providers
12/12/19Provider and Practitioner 2019 Annual Reminder
11/01/19IdealCare Provider Manual Update Notice – Diagnosis code pointer requirements
11/01/19IdealCare Provider Manual Update Notice – Effective 12/1/2019
10/01/19Chiropractic Services Billing Update Notice – Effective 11/1/2019
08/30/19IdealCare Provider Manual Update Notice – Effective 10/1/2019
08/26/19IdealCare Provider Manual Update Notice – Effective 8/26/2019
06/17/19IdealCare Provider Manual Update Notice – Effective 6/17/2019
05/01/19IdealCare Provider Manual Update Notice – Effective 5/1/2019
04/03/19QW Modifier Update – Effective 5/3/2019
03/01/19IdealCare Provider Manual and Prior Authorization List Update – Effective 4/1/2019
01/22/19DME Prior Authorization Required Supporting Documentation – Effective 1/22/2019
01/14/19Notice to Physicians and Providers
12/27/18IdealCare Provider Manual Update Notice – Effective 1/1/2019
12/24/18Registration Information – New Provider Portal effective 1/1/2019
11/30/18Changes to IdealCare Prior Authorization List – Effective 1/1/2019
11/30/18IdealCare Electronic Claims Process Update – Effective 1/1/2019
11/09/18IdealCare Claims and Customer Service Changes – Effective 1/1/19
09/05/18IdealCare Provider Manual Update Notice – Effective 9/5/2018
08/03/18Pharmaceutical Management Procedures Notice
08/02/18Financial Incentives Notice
07/17/18Medical Necessity Criteria Notice
07/01/18IdealCare Provider Manual Update Notice – Effective 7/1/2018
07/01/18Federal External Review Process
06/08/18IdealCare Provider Manual Update Notice – Effective 6/8/2018
05/01/18Reminder: IdealCare Reconsiderations & Appeals Process
03/30/18IdealCare Provider Manual Update – Effective 3/30/2018
03/14/18Consolidated Credentialing Verification Organization (CVO) presentation
02/20/18Consolidated Credentialing Verification Organization (CVO) Implementation to begin April 1, 2018

 

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*This amount was announced in June 2022.