PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

• The provider retains two a copy of the authorization and provides a copy to the Primary Care Provider (if
admitting provider is not the Primary Care Provider). The admitting provider shall also communicate
his/her plan of treatment with the member’s Primary Care Provider (Coordination of Care).
Facility Obligations for Admission
The following outline the facility obligations where inpatient services are needed:
Emergency Admissions:
• A member presents for care and requires hospitalization;
• The facility staff verifies eligibility and notifies the member’s Primary Care Provider.
• The patient is admitted.
• The facility staff cooperates with PCHP’s Medical Management staff as they perform
Concurrent/Retrospective Reviews;
• The facility staff will work with PCHP’s Medical Management staff in preparation of all discharge planning
and/or referral to outpatient/ancillary services including home health and DME; Note: Home health and
DME are not covered benefits of Parkland CHIP Perinate.
• The facility staff will notify the member’s primary care provider of all services performed while at the
facility (Coordination of Care).
Elective Admissions:
• A member presents for care and requires hospitalization (e.g., surgical procedure);
• The admitting doctor completes a prior authorization form (See Appendix A) and faxes it to PCHP’s
Medical Management Department at 1-800-240-0410. For elective admissions, the prior authorization form
must be received within 2 days of the scheduled admission.
• The approved referral form shall be presented at time of admission along with the member’s identification
card.
• The facility shall verify eligibility and admit the patient.
• The facility staff shall work with PCHP’s Medical Management staff in preparation of all discharge
planning and/or referral to outpatient/ancillary services including home health and DME. Note: home
health and DME are not covered benefits of Parkland CHIP Perinate.
• The facility staff shall notify the member’s primary care provider of all services performed while at the
facility (Coordination of Care).
Admission to Out-Of-Network Facilities
If a Parkland KIDSfirst, Parkland CHIP Perinate or Parkland CHIP Perinate Newborn member is admitted to a
non-participating facility, such an admission must first be approved by the member’s Primary Care Provider and
prior authorized by PCHP except in the case of an emergency. If a Parkland KIDSfirst, Parkland CHIP Perinate
or Parkland CHIP Perinate Newborn member has been admitted to a non-participating facility on an emergency
basis, the member should be transferred to a participating facility as soon as it is medically safe to do so. The
member’s Primary Care Provider will coordinate or PCHP MM staff will arrange the transfer.
Concurrent Review
Concurrent Reviews are performed to ensure that the care provided in the acute level setting is medically
necessary, assure that goals for length of stay (LOS) are appropriate, identify potential quality of care issues,
implement discharge planning, and capture data for claims payment. Concurrent reviews will be performed on
all hospitalized patients and begin within one (1) business day of admission. On-site review will be performed
if necessary. On-site review will be done in accordance with all hospital policies. Reviewers will identify
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