PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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Parkland CHIP Perinate Newborn Parkland CHIP Perinate 63
Pregnant Teens Please call Parkland KidsFirst as soon as you know that your Parkland KidsFirst patient is pregnant. She needs to apply immediately for services throuh Medicaid and her baby will also likely be able to receive health coverage through Medicaid. Call Member Services toll-free at 1-888-814-2352. This does not apply to CHIP Perinate members. Spell of Illness There is no spill of illness limitation for Parkland KidsFirst or Parkland CHIP Perinate newborn members. Value Added Services & Extra Benefits PCHP offer benefits and services in addition to basic CHIP covered services for our members. Some of these services are called “Value-added Services” because there are directly related to a member’s health care. Others are called “Extra Benefits” and are designed to enhance the lifestyle and health care experience for our members. PCHP provides the following value-added services and extra benefits: Value-added Services • Parkland Nurse Line 24 Hours a Day, 7 Days a Week – a 24 hour Nurse Help Line to help with health questions or to help parents decide what to do about their child’s health needs. • Free Membership to Boys and Girls Club of Greater Dallas – a program for young people between the ages of 6 and 18 who will be able to become a part of various health education programs and other activities. When members join these activities, they will help to develop the qualities needed to become responsible citizens and leaders. These programs include: Sports Activities, Fitness Activities, Recreation Activities, Character and Leadership Development, Education and Career Development, Health and Life Skills, and Educational Programs for The Arts. • Free Sports Physicals – PCHP members can access free sports physicals at one of Parkland’s Community Oriented Primary Care Clinic (COPC) or school based Youth and Family Clinics. One sports physical is available per year. • Free Newsletter – A program to help educate members on specific health topics. • Free Health Education Classes - Parkland KIDSfirst has classes for parents and children on many different health subjects. Gifts are provided to members who attend the special health education programs. Some of the classes are related to: - Child safety - Parenting skills - Getting ready for baby - Asthma, pediatric diabetes, etc. • Free infant car safety seat and gift bag for pregnant members who completed approved prenatal classes. Members need to call PCHP to locate approved prenatal classes. (Note: some limitations apply.) Parkland CHIP Perinate provides the following extra benefits: 64
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Parkland KIDSfirst, Parkland CHIP P
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Notification of Change in Provider
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CLAIMS SUBMISSION .................
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Quick Reference Checklist This manu
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Plan specified services. However, c
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CHIP Covered Services PCHP provides
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• Surgical implants • Other art
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Outpatient Mental Health Services I
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• Out-of-network services not aut
Page 20 and 21: CHIP Perinatal Covered Services Cov
Page 22 and 23: 15 Covered Benefit CHIP Perinate Ne
Page 24 and 25: Covered Benefit CHIP Perinate Newbo
Page 30 and 31: • Personal comfort items includin
Page 32 and 33: • Donor non-medical expenses •
Page 34 and 35: SUPPLIES COVERED EXCLUDED COMMENTS/
Page 36 and 37: SUPPLIES COVERED EXCLUDED COMMENTS/
Page 38 and 39: Coordination between Physical and B
Page 40 and 41: in the provision of care and servic
Page 42 and 43: statement indicating that members s
Page 44 and 45: As the Primary Care Provider you mu
Page 46 and 47: Other Access Standards Service Stan
Page 48 and 49: Members Right to Select Network Oph
Page 50 and 51: HMO/Provider Coordination PCHP will
Page 52 and 53: 45 • describe the range of medica
Page 54 and 55: Coordination of Care The Primary Ca
Page 56 and 57: Coordination with Texas Department
Page 58 and 59: Presentation at Emergency Room afte
Page 60 and 61: If the complaint is received verbal
Page 62 and 63: Expedited Appeal can be made verbal
Page 64 and 65: CHIP Eligibility CHIP KidsFirst Mem
Page 66 and 67: • Information concerning the grie
Page 69: Parkland Community Health Plan Memb
Page 73 and 74: your income. Co-payments do not app
Page 75 and 76: Member’s Right to Designate an OB
Page 77 and 78: 70 To report providers use this add
Page 79 and 80: 5. Network providers must report an
Page 81 and 82: To request to be a Specialist servi
Page 83 and 84: • OB/Gyn • Periodic Health Chec
Page 85 and 86: The table below provides HHSC Manag
Page 87 and 88: CHIP Cost Sharing Caps Members rece
Page 89 and 90: of these two dates: July 18, 2007,
Page 91 and 92: (DD) Diagnosis code by specific ser
Page 93 and 94: (PP) Attending physician ID (UB-04,
Page 95 and 96: (2) post-partum visits within 60 da
Page 97 and 98: CHIP Member Enrollment and Disenrol
Page 99 and 100: • In order to synchronize all CHI
Page 101 and 102: Provider Participation Requirements
Page 103 and 104: • Evidence of state licensure, an
Page 105 and 106: U1 U2 U3 Medically necessary delive
Page 107 and 108: PROCEDURE DESCRIPTION PROCEDURE COD
Page 109 and 110: provider actually treating the memb
Page 111 and 112: themselves appropriately and follow
Page 113 and 114: Medical Record Standards The medica
Page 115 and 116: 1. History and Physical Examination
Page 117 and 118: WIC services include providing nutr
Page 119 and 120: As soon as the member knows they wi
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3) by the director to the employee
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In addition to the previously state
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Prior Authorization The CHIP Perina
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Appendix A Universal Referral/Prior
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Appendix B Consent for Disclosure 1
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PERMISSION TO RELEASE CONFIDENTIAL
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EXAMPLE FORM PRIVATE PAY AGREEMENT
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Appendix D Clinical Practice Guidel
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Appendix D - Continued Clinical Pra
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Appendix D - Continued Clinical Pra
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RATIONALE: Attention-Deficit/ Hyper
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Appendix G Urinary Tract Infections
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Follow-up • Follow-up urine cultu
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RATIONALE: Prevention of RSV Illnes
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RATIONALE: Treatment of Group A Str
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PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

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