Electronic Funds Transfer
Electronic Remittance Advice
Provider Claims and Appeals
Prior authorization is the review of the medical necessity and appropriateness of selected health services before they are provided. Annual review of prior authorization criteria was completed on 1/14/2020.
Refer to the provider manual for more information regarding the prior authorization process.
- Online Provider Authorization Search Tool - can also be used to determine if prior authorization (PA) is required for services.
- Texas Standard Prior Authorization Request Form for Health Care Services
- Adverse Determination Letter Template
- Parkland Healthfirst – Medicaid
- Parkland Medicaid Member Rights
- Parkland Kidsfirst– CHIP
Tips for requesting authorizations:
- ALWAYS verify member eligibility prior to providing services
- Complete all entire form and attach supporting documentation prior to submitting
- Submit the request timely to ensure Prior Authorization staff have 3 business days to complete the review
Remember, a request for prior authorization is not a guarantee of payment. Unauthorized services will not be reimbursed.
To request an authorization, find out what services require authorization or check on the status of an authorization, visit our provider secure web portal. For more information about prior authorization, review your provider manual.
Texas Referral Authorization Form