PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

(PP) Attending physician ID (UB-04, field 76, qualifier portion) is required.
Disclosure of Necessary Attachments: Parkland Community Health Plan will not require an attachment as
described in Texas Administrative Code Title 28, Part 1, Chapter 21, Subchapter T, Rule § 21.2803 unless it has
given the physician or provider at least 60 calendar days notice before requiring the attachment. The notice will
be contained in a revision to the Provider Manual. (Texas Administrative Code Title 28, Part 1, Chapter 21,
Subchapter T, Rule § 21.2804)
Disclosure of Additional Clean Claim Elements: Should Parkland Community Health Plan decide that it
needs to require additional elements for clean claims, these additional elements will be communicated to the
physician or provider in a revision to the Provider Manual at least 60 calendar days before requiring the
additional elements as elements of a clean claim. (Texas Administrative Code Title 28, Part 1, Chapter 21,
Subchapter T, Rule § 21.2805.)
Disclosure of Revision of Data Elements, Attachments, or Additional Clean Claim Elements: Should
Parkland Community Health Plan decide that it needs to revise its requirements for data elements, attachments
or additional clean claim elements, it will provide at least 60 calendar days notice to the physician or provider.
Hospital Facility Claims for Parkland CHIP Perinate and Parkland CHIP Perinate Newborn
Clients at or below 185% of Federal Poverty Level:
Hospital facility charges related to a Parkland CHIP Perinate member’s labor with delivery, and the initial
hospital admission of a Parkland CHIP Perinate Newborn member is covered by Emergency Medicaid.
Hospitals will need to work with these members to apply for Emergency Medicaid upon presentation to the
hospital for services. These claims will be billed to Texas Medicaid and Healthcare Partnership (TMHP)
through the TMHP normal billing processes. Please contact TMHP at 1-800-925-9126 or visit their website at
www.tmhp.com for details their billing process.
Any hospital services rendered to Parkland CHIP Perinate Newborn members after the original newborn
hospital discharge will not be considered for reimbursement under Emergency Medicaid, but can be covered
under CHIP (see the CHIP Perinate Newborn scope of benefits), Hospitals should urge mothers to apply for
“regular” Medicaid for the newborn only if the child has a medical condition that is not considered normal for a
newborn.
FQHC/RHC Reimbursement
FQHCs
STAR
Type of Service Codes to Bill Reimbursement
General Services T1015 (CMS 1450) Encounter rate
THSteps CPT (CMS 1500) Encounter rate
Family Planning CPT (CMS 1500) Encounter rate
Vision CPT (CMS 1500) Encounter rate
Behavioral Health CPT (CMS 1500) Encounter rate
CHIP
Type of Service Codes to Bill Reimbursement
General Services T1015 (CMS 1450) Encounter rate
Well child check ups CPT (CMS 1500) Encounter rate
Vision CPT (CMS 1500) Encounter rate
Behavioral Health CPT (CMS 1500) Encounter rate
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