PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

Note: It is strongly recommended that providers submitting paper appeals retain a copy of the documentation
being sent. It also is recommended that paper documentation be sent via certified mail with a return receipt
requested. This documentation provides proof that the claims were received by PCHP, which is particularly
important if it is necessary to prove that the 120-day appeals deadline has been met. The provider might need to
keep such proof regarding multiple claims submissions if the Medicaid TPI is pending.
Medicare crossovers and inpatient hospital appeals related to medical necessity denials or DRG assignment/
adjustment must be submitted on paper with the appropriate documentation. Submit correspondence,
adjustments, and appeals (including routine inpatient hospital claims) to the following address:
Appeals
Parkland Community Health Plan
PO Box 569005
Dallas, TX 75256-9005
Proof of Timely Filing
Acceptable forms proving timely filing are:
• Written claims log, indicating the disputed claim
• The electronic confirmation if acceptance of the electronic claim that the PCHP claims clearinghouse sends
to the provider.
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