PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

As the Primary Care Provider you must provide or arrange for follow-up care after emergency or inpatient care.
As the Primary Care Provider, you can provide Behavioral Health services within your scope of practice.
Primary Care Providers for children under the age of 19 must ensure that the member receives all services
required for Early Childhood Intervention (ECI), prenatal care, WIC, children with disabilities or chronic or
complex conditions, and health education and wellness where applicable.
Primary Care Providers will provide services such as well child health checkup in accordance with the
American Academy of Pediatric recommendations. The Primary Care Provider has the following
responsibilities:
• All PCHP participating Primary Care Providers, groups, and/or extenders shall provide all primary care
covered services within the scope of the physician’s practice as required by his/her membership panel
and as outlined in the “Physician Agreement.”
• A Primary Care Provider is responsible for providing or arranging for the provision of services to
members assigned to their panel.
• The Primary Care Provider is responsible for seeking prior authorization from PCHP when referring to
non-participating providers.
• When prior-authorization is required, the Primary Care Provider or admitting doctor will begin the
request.
• The Primary Care Provider recognizes the role that the family members have as primary caregivers for
children and other dependents and assures their participation in decision making.
Provider Responsibilities
The Primary Care Provider will:
• Provide appropriate health education and instructions to the member or member guardian as appropriate.
• Assure appropriate transfer of medical information between the primary care providers, specialty care
providers, and ancillary care providers.
• Assure that discharge planning is conducted for each admitted member.
• Assure that pre-admission planning occurs for the member in all non-emergency hospital admissions.
• Assure that the home and community arrangements are available before the hospital discharge of the
member in need of home health services.
• Provide information concerning appropriate support services (e.g., WIC, DHS, ECI, etc) within the
community.
• Provide after hours call coverage.
• Provide assistance with hospital arrangements; including meeting members in the Emergency Room
(ER) or calling the ER with relevant information about the member.
• Help in the development of alternatives to hospitalization when medically appropriate.
• Provide timely follow-up after emergency care or hospitalization.
• Follow the Plan guidelines, including updated changes, benefits, limitations to program, etc.
Contract Effective Date
New providers who enter into a valid contract and have been credentialed by PCHP will be assigned a network
participation effective date. The provider’s effective date will be fifteen (15) business days from the date the
provider was credentialed or the date a valid contract and documentation was received by PCHP, whichever is
later.
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