Sendero Health Plans,
Sendero Health Plans, Prior Authorization
Prior authorization is required for certain medical and behavioral health services. Sendero’s provider materials say requests may be submitted by the…
Short answer
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…
Sendero Health Plans, publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.
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
How to submit prior authorization requests
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telephone
-
fax
-
HIPAA-secure encrypted email
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
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Provider Manual - UM contact methods and criteria | Prior authorization requests may be received via telephone, fax or HIPAA secure encrypted email; Sendero uses a mix of InterQual and internal policies. | Official | high |
| Provider page - preauthorization tools and notices | Provider page links to the interactive lookup tool, PA drug list, and multiple effective-date preauthorization lists; Sendero says it uses InterQual and internal criteria and will provide criteria upon request. | Official | high |
| Member FAQ / members page - decision timeframes | Urgent prior authorization decisions within 1 working day or 72 hours, whichever is more stringent; non-urgent within 3 calendar days. | Official | high |
Last reviewed: March 27, 2026
Sources used: 3 official
Automating prior authorization work
Clark Street Health is testing early-access workflows for requirements checks, status follow-up, document routing, and staff exceptions. Payer rules and clinical decisions still need the controls defined by your practice.
Review the prior authorization workflow