Claims

You can mail paper claims to the following address:   

Parkland Community Health Plan
Attn: Claims Department
PO Box 61088
Phoenix, AZ 85082

Electronic claims should be submitted through the PCHP clearing house Emdeon. The claims must be submitted using the payer ID#66917. CMS 1500s can be submitted in the standard NSF 2.0

For claims processing guidelines, please refer to the provider manual. 

A claim appeal is a written request by a provider to give further consideration to a claim reimbursement decision based on the original and or additionally submitted information. The document submitted by the provider must include verbiage including the word “appeal”.

An appeal must meet the following requirements:

  • It is a written request to Appeal a claim
  • You're now requesting further consideration based on the original and or additionally submitted information
  • The document submitted must include verbiage including the word “appeal”. The claim may be appealed in writing by completing an appeal Claims and Appeals Form or by completing the following:
  • Parkland Community Health Plan will process appeals and adjudicate the claim within thirty (30) days from the date of receipt. A provider may appeal any disposition of a claim.
  • Submit a copy of the Remit/EOB page on which the claim is paid or denied.
  • Submit one copy of the Remit/EOB for each claim appealed.
  • Circle all appealed claims per Remit/EOB page.
  • Identify the reason for the appeal. 
  • If applicable, indicate the incorrect information and provide the corrected information that should be used to appeal the claim.
  • Attach a copy of any supporting documentation that is required or has been requested by Parkland Community Health Plan.  Supporting documentation to prove timely filing should be the acceptance report from Parkland Community Health Plan to the provider’s claims clearinghouse. Supporting documentation must be on a separate page and not copied on the opposite side of the Remit/EOB.
  • Please submit your appeals and all supporting documentation to the following address:
    • Verbally by calling: HEALTHfirst- 1-888-672-2277 or KIDSfirst-  1-888-814-2352
    • By fax: 1-877-223-4580
    • By mail: Parkland Community Health Plan Appeals and Correspondence
      P.O. Box 569005
      Dallas, TX 75356-9005

By Email Click Here – Providers can submit Complaint and Appeals.  Please include supporting documentation for the Complaint and Appeal upon submission.