PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

CHIP Perinatal Provider Responsibilities
Prenatal Care
As a CHIP Perinate provider, the assigned medical professional is responsible for providing the needed care for
the CHIP Perinate member related to prenatal visits and labor with delivery of the eligible unborn child. CHIP
Perinatal providers can include a Physician, Physician’s Assistant, or Advanced Practice Nurse who is
contracted with PCHP to provide Covered Health Services to an unborn child and who is responsible for
providing initial and primary care, maintaining the continuity of care and initiating referrals for care.
When enrolling in Parkland CHIP Perinate, each member will pick a perinatal provider who participates in
Parkland CHIP Perinate. The perinatal provider will provide covered services for the member and arrange for
any required prior authorization from PCHP. To learn more please see the Referrals section of this manual.
Participating providers will abide by PCHP policies regarding preventive care and health education to members
during each office visit and will document such services in the member’s medical records.
As the Perinatal provider you must provide primary prenatal care services and continuity of care to members
who are enrolled with or assigned to you. Perinatal Care Services are all services that are considered medically
necessary according to the definition found on page 22 in relation to the Covered Benefits for the CHIP Perinate
member. All services must be provided in compliance with generally accepted medical standards for the
community in which services are rendered.
As the Perinatal provider, you must insure integration of member’s medical home needs with home and
community resources which provide medical nutritional, behavioral, educational and outreach services available
to members.
As the Perinatal provider, you must call the emergency room with relevant information about the member when
necessary.
As the Perinatal provider, you must provide or arrange for follow-up care after emergency or inpatient care.
Provider Accessibility
PCHP must ensure that members have access to a CHIP Perinatal services according to Texas Department of
Insurance mileage standards.
Parkland CHIP Perinate providers must adhere to the following access guidelines:
• Urgent care – within 24 hours
• Routine care – within 2 weeks
• Prenatal care – within 2 weeks of request
• High risk pregnancy or new member visits – within 5 days or immediately
Responsibility to Verify Member Eligibility and/or Authorization for Services
All Parkland CHIP Perinate members are issued an ID card at the time of enrollment with us. Eligibility should
be verified before rendering services through the following resources:
• Access to website www.parklandhmo.org
• Contact Parkland CHIP Perinate Member Services
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