PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

• Evidence of state licensure, and of compliance with any other applicable state and federal requirements;
• Evidence of approval by a recognized accrediting body. If the provider is not accredited, PCHP will
evaluate the provider against established standards.
PCHP shall recredential institutional providers at least every three years.
Referrals
Referrals to other participating providers, other than the member’s Primary Care Provider, require completion
of a referral form by the Primary Care Provider. The provider and participating specialist are expected to
communicate regarding the health care services given to each member.
In-Network Referrals
The Parkland KIDSfirst, or Parkland CHIP Perinate Newborn member’s Primary Care Provider is responsible
for and will coordinate referrals of the member to other providers, in- and out-of-network. The steps for an innetwork
referral are listed below:
• A member presents for care and requires referral for services;
• The Parkland KIDSfirst, or Parkland CHIP Perinate Newborn member’s Primary Care Provider completes a
referral form.
The in-plan referral is valid for thirty (30) days for a maximum of two visits unless otherwise authorized
by the Primary Care Provider. A new referral request must be completed if the referral is over thirty
(30) days old or if more than two visits are required.
Direct Access Services
Parkland KIDSfirst and Parkland CHIP Perinate Newborn members can seek the following services without a
referral from a Primary Care Provider:
• OB/GYN
• Value-Added services
• Well Child Services
• Behavioral Health
Referrals to Ancillary Services
All providers can refer members for routine laboratory and radiology services to a PCHP participating provider
using the standard PCHP referral form. However, some procedures require prior authorization. Please see the
Prior Authorization section for a comprehensive listing of these procedures. PCHP providers are required to
send routine lab and radiology requests to one of the lab/radiology providers listed in the Parkland KIDSfirst,
Parkland CHIP Perinate or Parkland CHIP Perinate Newborn Provider Directory. If a required radiological
service is not available within the Parkland KIDSfirst, Parkland CHIP Perinate or Parkland CHIP Perinate
Newborn network, the member’s Primary Care Provider or CHIP Perinatal provider must complete a prior
authorization using the Texas Referral/Authorization Form and follow the standard out-of-network referral
procedures outlined above.
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