PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

Presentation at Emergency Room after Hours
If a PCHP member presents for care at an Emergency Room after normal business hours, covered services will
not be denied. The Emergency Room staff should inform the member’s health plan and the member’s primary
provider (Primary Care Provider or CHIP Perinatal provider) no later than the next business day. All follow-up
care should be referred to the member’s primary provider. Note: Parkland CHIP Perinate members have
limited benefits. Please refer to the CHIP Perinate Covered Services section of this manual for details on
covered and excluded emergency and outpatient services.
Presentation at Emergency Room during Normal Business Hours
If a PCHP member presents for care at an Emergency Room during normal business hours, the Emergency
Room staff should contact the member’s primary provider (Primary Care Provider or CHIP Perinatal provider)
and await the primary provider’s recommendation (e.g., come to office, be seen at ER, etc.), unless the patient’s
condition is emergent. Should the primary provider direct that care be rendered at the ER, the staff should
document the primary provider’s instructions in the member’s medical record and proceed accordingly. All
follow-up care should be referred to the member’s primary provider. Note: Parkland CHIP Perinate members
have limited benefits. Please refer to the CHIP Perinate Covered Services section of this manual for details on
covered and excluded emergency and outpatient services.
Emergency Services and Care
If member needs immediate treatment, proceed and treat. Within 24 hours of an emergency admission or an
emergency room visit, the provider must notify PCHP and the Primary Care Provider with the following
information:
• Member’s full name
• Member ID number
• Diagnosis for emergency admission
• Facility where member was admitted
• Admitting physician name
Emergency Admission
The member’s primary provider (Primary Care Provider or CHIP Perinatal provider) or the admitting
Emergency Room must call Parkland PCHP’s Patient Management Department at 1-888-814-2352 to inform
the health plan of any emergency hospital admission for a PCHP member. PCHP must be notified within one
(1) business day.
Emergency Ambulance Services
When the PCHP member’s condition is life-threatening, and trained attendants must use special equipment, life
support systems, or close monitoring while en-route to the nearest appropriate facility, the ambulance transport
is deemed an emergency service.
Non-Emergency Ambulance Service
When a PCHP member has a medical problem requiring treatment in another location and is so severely
disabled that the use of an ambulance is the only appropriate means of transfer, the ambulance service must be
approved and coordinated by PCHP. Non-emergency transport service for a CHIP member with severe
disabilities must be to or from a scheduled medical appointment. Non-emergency ambulance services are not a
benefit for the Parkland CHIP Perinate member.
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