Sendero Health Plans, Prior Authorization

Sendero Health Plans, prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Prior authorization is required for certain medical and behavioral health services. Sendero’s provider materials say requests may be submitted by the provider’s office via telephone, fax, or HIPAA-secure encrypted email, and that Sendero uses InterQual plus internal criteria. The public member-facing content states urgent requests are decided within 1 working day or 72 hours, whichever is more stringent, and non-urgent requests within 3 calendar days.
• The public provider page lists preauthorization-related documents and tools but does not expose the full list of services in the HTML snippet reviewed; use the current online preauthorization list or lookup tool for plan- and date-specific requirements.
• Some requirements may vary by line of business and effective date.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• telephone

• fax

• HIPAA-secure encrypted email

• Submission resource 1

Information commonly required

• Specific service/procedure request
• Supporting clinical information sufficient for medical necessity review
• Provider office contact information

Turnaround notes and caveats

• Urgent requests: within 1 working day or 72 hours of receipt, whichever is more stringent.
• Non-urgent requests: within 3 calendar days.
• Sendero states it can provide a copy of the proprietary criteria for any specific authorization upon request.
• The public provider page lists preauthorization-related documents and tools but does not expose the full list of services in the HTML snippet reviewed; use the current online preauthorization list or lookup tool for plan- and date-specific requirements.
• Some requirements may vary by line of business and effective date.

Provider resources

• Provider Portal Login (official)
• Provider Resources / Provider page (official)
• Provider Manual (rev. 11-26-24) (official)
• Provider Portal User Guide (official)
• Prior Authorization Process Description (official)
• Claim Reconsideration/Appeal Request Form (official)
• Preauthorization Code Interactive Lookup Tool (official)

Sources