Frequently Asked Questions (FAQs)
To better serve our Sendero Health Plans physicians and providers, we have compiled some of the most frequently asked questions below.
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CLAIMS AND BILLING
Q: Where do I submit claims?
The claims mailing address is:
Sendero Health Plans
Electronic claims submission:
Please verify that your current clearinghouse can process through to Emdeon. Our EDI payor ID is 36426.
For questions regarding filing a Reconsideration or Appeal for non-payment of a claim please call Sendero Customer Service at 1-844-872-0537, email firstname.lastname@example.org or fax at 512-901-9704.
Q: What is the timeframe for filing claims and appeals?
The deadline for claims submission is 95 days from the date of service.
Claim appeals must be written and filed within 120 days of the date of the Explanation of Payment (EOP)
Q: What is the timeframe for payment on clean claims?
Sendero has a 30 day clean claim payment period to either pay the claim in accordance to the provider’s contract or deny the claim entirely or partially.
Q: How do I check claims status?
You can check claims status via Sendero’s web portal at https://senderosc.alderaplatform.com/. You may also contact Sendero Provider Services at 1-844-872-0537 for additional assistance with claims status.
Q: Who do I call if I have a claim issue?
Contact Sendero Provider Services at 1-844-872-0537 or our Network Management team at 1-855-895-0475 for additional assistance.
Q: Do you provide Electronic Funds Transfer (EFT)?
Yes, a copy of the EFT form can be found in the Sendero Provider Manual, on this website or by calling your Network Management Representative.
Q: I am submitting paper claims and they are being returned to me for correction in field 33. What is going on?
In accordance with the HIPAA 5010 compliance mandate, the scanning protocols to convert a paper claim to a 5010-837 claim is to move field 33 to the BILLING PROVIDER loop of the 837. This loop is required by 5010 convention to have a street address. Providers who are submitting PO Box addresses in field 33 of their paper CMS1500 will be returned to the provider for correction. The claims will not be date stamped, thus not be accepted as received. A cover letter will be placed on top of these claims instructing the provider of the requirement change for resubmission.
Q: Does Sendero provide interpreters, when needed? If so, what is the process to request this?
Sendero Health Plans provides interpretation assistance through qualified professionals who can assist you with interpretation services in your office. Please call Sendero Provider Services at 1-844-872-0537 and provide the following information:
If you need an interpreter in the office when the Member sees you, please call or have the Member call Sendero Provider Services at least 48 hours before his/her appointment to schedule these services.
Q: Does Sendero have a Cultural Competency Policy?
Sendero places great emphasis on the wellness of its Members and recognizes that a large part of health care delivery is treating the whole person and not just a medical condition. Sensitivity to differing cultural influences, beliefs and backgrounds can improve a provider’s relationship with Members and in the health and wellness of the patients themselves. Sendero encourages all providers to be sensitive to varying cultures in the community. Please see the Sendero Provider Manual Section 3.16 Cultural Sensitivity for more information.
Q: How do I submit prior authorization requests?
Admission notification and Prior Authorization requests can be submitted by:
A copy of the Texas Referral/Authorization Form can be found in Appendix A of the Sendero Provider Manual, on this website or by calling your Network Management Representative
Q: What is the process for referrals?
Referrals to in-network providers do not require prior authorization. The Texas Referral/Authorization Form should be filled out and given to the Member when referring to specialists or other ancillary providers for medically necessary services within the Sendero Health Plans network. Please explain to the Member that the Specialist may not see the Member without this form.
MEMBER ENROLLMENT AND ELIGIBILITY
Q: What is the process to check Member eligibility?
The provider is responsible for verifying Member eligibility at the time of the office visit. To verify STAR or CHIP eligibility, please visit Sendero’s web portal here. Not registered for the web portal? Click here for a registration form. Sendero Member eligibility can also be verified via Sendero Provider Services at 1-844-872-0537.
Q: What is the process for changing a PCP?
PCP changes are made by calling Sendero Provider Services at 1-844-872-0537. The Member or the Member’s guardian may make a PCP change.