Frequently Asked Questions (FAQs) - MEDICAID/CHIP EXIT

You may have heard that Sendero Health Plans (SHP) will be exiting STAR and CHIP in the Travis Service Area effective May 1, 2018. We want you to know that it has been an honor to provide your health insurance coverage, and we have enjoyed the opportunity to work with you and your Providers in helping you and your family get the care you need.

Where do I file my claim for services rendered to Sendero members?

The billing process has not changed. Sendero will process claims for dates of service on or before April 30, 2018, for Medicaid/CHIP covered services, within the required timeframes. Timely filing requirements for these claims will be strictly adhered to in an effort to adjudicate all claims by the end of the runout period.

Who do I call to appeal a claim denial?

A Level I Claims appeals must be filed in writing within 120 calendar days of the initial decision (Explanation of Payment (EOP) or medical necessity determination). Level I Appeals can be filed to the following address:

Sendero Health Plans
Attn: Sendero Reconsiderations
PO Box 15507
Austin, TX 78761

A Level II Claim appeal must be filed in writing with supporting documentation or to the Sendero provider portal at https://senderohealth.mediview.net within 30 calendar days of the reconsideration decision. Level II Appeals can be filed to the following address:

Sendero Health Plans
Attn: Sendero Appeals
2028 E. Ben White Blvd, Suite 400
Austin, TX 78741

How will I know where my patients have been reassigned?

Please contact the TMHP AIS line at 1-800-925-9126.to obtain the information.

How long can I receive authorizations from Sendero?

You can obtain authorizations up to 11:59pm on April 30, 2018.

What is the last date that I will receive a PCP Panel Report from Sendero?

The last member panel report will be available on the provider portal no later than 04/05/2018.