Mon. – Fri. 8AM – 5PM
1-844-800-4693
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.
| ● | 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 SenderoProviderContracts@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.
Forms
The following forms are required to be completed when submitting prior authorization requests for the medications listed below: