PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

1. Tax identification number
2. Office address
3. Billing address
4. Phone number
5. Billing County
6. Specialty
7. New provider additions/deletions to practice
8. Current license (Drug Enforcement Agency, Department of Public Safety, state license, and malpractice
insurance) and its expiration date
9. Status of Board Certification
10. Status of Hospital Privileges (if applicable)
If you plan to move your office, open a new location, or you leave your current practice, you should provide
written notice at least ninety (90) days before any planned change. By providing this information, you will
ensure the following:
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• Your practice is properly listed in the PCHP Provider Directory;
• Payments made to you or your group are properly reported to the Internal Revenue Service; and,
• PCHP members are notified in time to change their provider if they so desire as a result of the change.
Forward correspondence to:
Parkland Community Health Plan Inc.
Provider Relations Department
2777 Stemmons Freeway, Suite 1750
Dallas, Texas 75207
Laboratory Tests
PCHP providers must refer laboratory tests to in-network facilities and contractors. Exceptions must be
approved by PCHP Patient Management. Please refer to the PCHP provider directory or contact Provider
Relations at 1-888-814-2352 for information or assistance.
Referrals
Referrals to providers, other than the member’s Primary Care Provider, require approval or completion of a
referral form by Primary Care Provider. Providers should refer members to network facilities and contractors.
Please review the “Referral” sub-section of the Medical Management Section of this Manual.
Prior Authorization
The provider might need to obtain prior authorization from PCHP before initiating certain procedures,
admissions or specialty services. Please review the list of services and procedures requiring prior authorization
as documented in the “Pre-authorization” section of this manual.
Specialty Services Available without Referral
PCHP members can use the services of the following specialties without a referral from the Primary Care
Provider to any in network provider: