Information & Resources

In this section, you’ll find a number of resources to assist you in serving our Parkland Commuity Health Plan members. Remember, you can always find more information in our provider manual.

 

All patient identifiable information must meet the confidentiality regulations as specified by the Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Parkland Community Health Plan network providers must treat all information that is obtained through the performance of health services as confidential information to the extent that confidential treatment is provided under state and federal laws, rules and regulations. This includes, but is not limited to, information relating to applicants or recipients of HHSC Programs.

As a provider to our members, it is important that you know our members have rights and responsibilities.

It is widely known that providing primary prevention services, such childhood immunizations, can reduce the incidence of illness, disease and accidents. Secondary prevention services, such as early detection of potentially serious illnesses, may reduce the impact of the illness on the patient, thereby decreasing the cost of care. Each primary care office visit should be viewed as the only opportunity for a comprehensive assessment of the member’s health status.

We encourage providers delivering well-child care to Parkland Community Health Plan members to use the American Academy of Pediatrics (AAP) Preventive Health Guidelines

Contact our Provider Relations group for important details about our clinical programs and guidelines as well as resources to assist you with coding, billing practices, formularies and improving patient care quality.

Provider Relations Hotlines:
Parkland HEALTHfirst     Medicaid STAR            1-888-672-2277
Parkland KIDSfirst         CHIP/CHIP Perinate     1-888-814-2352

Our Provider hotline is available Monday through Friday, 8:00 a.m. to 5:00 p.m. Central time, excluding State-approved holidays. Providers also have 24/7/365 by utilizing self-service tools such as our interactive voice response (IVR) system and provider portal for eligibility and benefit questions.

Access to Care Guidelines

Provider Relations Department List

Prior authorization is the review of the medical necessity and appropriateness of selected health services before they are provided. The prior authorization list is reviewed and revised periodically to ensure only those services that are medical management issues are subject to review by the health plan and approved before the services are eligible for reimbursement.

Refer to the provider manual for more information regarding the prior authorization process.

 

Provider Orientation

 

Texas Health Steps
Texas Health Steps offers FREE continuing education courses designed to help enhance preventive health, mental health, oral health and case management services to children who are Medicaid eligible in Texas.

Learn more and register for an online Texas Health Steps training provided by the Department of State Health Services (DSHS).

Texas Medicaid & Healthcare Partnership (TMHP) is a group of contractors under the leadership of Accenture. Accenture administers Texas Medicaid and other state health-care programs on behalf of the Texas Health and Human Services Commission.

Texas Health and Human Services Commission (HHSC) works to maintain and improve the health and human services system in Texas and to administer its programs in accordance with the highest standards of customer service and accountability for the effective use of funds.

HHSC oversees the operations of the health and human services system, provides administrative oversight of Texas health and human services programs, and provides direct administration of some programs.

On behalf of the Parkland Healthfirst, we would like to welcome both new and existing providers to our Adoption Assistance and Permanency Care Assistance program (AAPCA) We are pleased you have decided to participate with our plan.  Effective September 1st, 2017 children and youth in the Adoption Assistance and Permanency Care (AA/PCA) population will align to our STAR program.

The Adoption Assistance (AA) program provides help for certain children who are adopted from foster care. The Permanency Care Assistance (PCA) program gives financial support to family members who provide permanent home to children who were in foster care but could not be reunited with their parents.

We ask that you continue to access our Provider Manual for additional information about this program and other plan benefits. If you have additional questions, please refer to our Provider Relations Contact information listed on our Provider website landing page.

Updates in head and neck cancer

Antibiotic Use in the United States, 2017: Progress and Opportunities

Antibiotic Stewardship CME

Rubicon CME on Demand Grand Rounds

On Demand CME FAQs

For CME credit:  After completing the course the physician is sent an email with instructions on claiming CME credit.