Provider Resources

 

In this section, you’ll find a number of resources to assist you in serving our Parkland Community Health Plan members. Remember, you can always find more information in our provider manual.

Parkland Community Health Plan (PCHP) has partnered with Change Healthcare and ECHO Health, Inc. to provide more choice in payment methods in order to meet providers’ requests for more payment options.

The new payment system will allow your office the ability to receive a virtual credit card (VCC), an Automated Clearing House (ACH)/Electronic Funds Transfer (EFT), or check payment.

You have two enrollment options to sign up for EFT:

Option 1: Enrollment with only Parkland Community HealthPlan (no fees apply) visit, https://enrollments.echohealthinc.com/EFTERAdirect/ParklandCommunityHealthPlan

Option 2: Enrollment to receive EFT from All Payers processing payments on the Settlement Advocated platform (A fee for this service will apply) visit, https://enrollments.echohealthinc.com.

Resources:

If you have additional questions regarding your payment options, please contact ECHO Health at 888-927-6260.

All patient identifiable information must meet the confidentiality regulations as specified by the Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Parkland Community Health Plan network providers must treat all information that is obtained through the performance of health services as confidential information to the extent that confidential treatment is provided under state and federal laws, rules and regulations. This includes, but is not limited to, information relating to applicants or recipients of HHSC Programs.

Texas Medicaid & Healthcare Partnership (TMHP) is a group of contractors under the leadership of Accenture. Accenture administers Texas Medicaid and other state healthcare programs on behalf of the Texas Health and Human Services Commission.

Texas Health and Human Services Commission (HHSC) works to maintain and improve the health and human services system in Texas and to administer its programs in accordance with the highest standards of customer service and accountability for the effective use of funds.

HHSC oversees the operations of the health and human services system, provides administrative oversight of Texas health and human services programs, and provides direct administration of some programs.

We are pleased you have decided to participate with our plan. Effective September 1, 2017 children and youth in the Adoption Assistance and Permanency Care Assistance program (AAPCA) population will align to our STAR program.

The Adoption Assistance (AA) program provides help for certain children who are adopted from foster care. The Permanency Care Assistance (PCA) program gives financial support to family members who provide a permanent home to children who were in foster care but could not be reunited with their parents.

We ask that you continue to access our Provider Manual for additional information about this program and other plan benefits. If you have additional questions, please refer to our Provider Relations Contact information listed on our Provider website landing page.

The CSHCN benefits program administered by the Health and Human Services Commission provides services and benefits to clients age 20 and younger who have special healthcare needs and people with cystic fibrosis of any age to improve their health, well-being and quality of life.

The Children with Special Health Care Needs Systems Development Group, administered by the Texas Department of State Health Services, works to strengthen community-based services to improve systems of care for children and youth with special health care needs (CSHCN).

Texas Health Steps (EPSDT) was transferred to the Health and Human Services Commission in September 2016, as a result of agency structural changes passed by the 84th Texas Legislature. The transition of all website information pertaining to THS from the DSHS website to the HHSC website was finalized in late August 2019.  To ensure providers and Medicaid recipients have access to the information and resources they need, go to the new HHSC THS website.

Effective June 1, 2021, Texas Health Steps has added two additional screening tools for Texas Health Steps preventive care medical checkups:

  • The Survey of Well-being of Young Children (SWYC) will be added as a recognized developmental screening tool for children. 
  • The Rapid Assessment for Adolescent Preventive Services (RAAPS) will be added as a recognized mental health screening tool for adolescents who are 12 through 18 years of age.

Please see the TMHP provider notice for additional information:Developmental Screening and Mental Health Screening Tools Added for Texas Health Steps”.

For questions or to contact THS Regional Provider Relations Staff, download/view a current .pdf listing by location which is available from the "Download PDF arrow" on the right side of your screen.

Information on Case Management for Children and Pregnant Women

Find food assistance, help paying bills, and other free or reduced cost programs, including new programs for the COVID-19 pandemic at www.findhelp.org.

WIC provides support and inspiration to eat right, have a healthy pregnancy, breastfeed successfully, and raise amazing kids. Learn more by visiting their website.

The Texas Department of Family and Protective Services (DFPS) has a central place to report:

  • Child abuse and neglect.
  • Abuse, neglect, self-neglect, and exploitation of the elderly or adults with disabilities living at home.
  • Abuse of children in child-care facilities or treatment centers.
  • Abuse of adults and children who live in state facilities or are being helped by programs for people with mental illness or intellectual disabilities. These reports are investigated by HHSC Provider Investigations, not DFPS.

Texas law says anyone who thinks a child, or person 65 years or older, or an adult with disabilities is being abused, neglected, or exploited must report it to DFPS.

Call our Abuse Hotline toll-free 24 hours a day, 7 days a week, nationwide, or report with our secure website and get a response within 24 hours.

The Family Planning Program helps fund clinic sites across the state to provide quality, comprehensive, low-cost and accessible family planning and reproductive healthcare services to women and men in Texas.

The newly redesigned HealthyTexasWomen.org makes it easier to get information about the women's healthcare services Texas Health and Human Services offers.

Our Case Management department uses a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services to meet our members' healthcare needs through communication and available resources to promote quality, cost effective outcomes (Source: Care Management Society of America). We at the Parkland Community Health Plan attempt to assist in the efficient utilization of medical resources for our members with special health care needs, including highly complex chronic and catastrophic cases, to improve access to quality care and avoid unnecessary medical costs. Members who might benefit from education, care, service and/or resource coordination services are identified for case management through utilization management activities, health risk assessments and screening of administrative data.

Clinical practice guidelines summarize evidence-based management and treatment options for specific diseases or conditions.

Practice guidelines are developed nationally and adopted locally through the Provider Advisory Committee that includes practicing physicians who participate in the plan. This group also suggests topics for guideline development, based on relevance to enrolled membership, with high-volume, high-risk, problem-prone conditions as the first priority.

The Parkland Community Health Medicaid and CHIP programs have adopted the following guidelines:

Good communication between members and providers contributes directly to patient satisfaction and positive outcomes

A culturally competent provider effectively communicates with patients and understands their individual concerns. It’s incumbent on providers to make sure patients understand their care regimen.

To improve individual health and build healthy communities, providers need to recognize and address the unique culture, language and health literacy of diverse consumers and communities. The Aetna Better Health Cultural Competency program is geared toward the following:

  • Improving healthcare access and utilization
  • Enhancing the quality of services within culturally diverse and underserved communities
  • Promoting cultural and linguistic competence as essential approaches in the elimination of health disparities.

Additional provider-focused cultural competency resources can be found with U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA).

Culture is a major factor in how people respond to health services. If affects their approach to:

  • Coping with illness
  • Accessing care
  • Working toward recovery

Providers receive education about such important topics as:

  • The reluctance of certain cultures to discuss mental health issues and of the need to proactively encourage members from such backgrounds to seek needed treatment
  • The impact that a member’s religious and/or cultural beliefs can have on health outcomes (e.g. belief in non-traditional healing practices)
  • The problem of health illiteracy and the need to provide patients with understandable health information (e.g. simple diagrams, communicating in the vernacular, etc.)
  • History of the disability rights movement and the progression of civil rights for people with disabilities
  • Physical and programmatic barriers that impact people with disabilities accessing meaningful care

As part of our cultural competency program, we encourage our providers to access information on the Office of Minority Health's web-based A Physician's Guide to Culturally Competent Care. The American Medical Association, American Academy of Family Physicians and the American College of Physicians endorse this program, which provides up to 9.0 hours of category 1 AMA credits at no cost.

Parkland Community Health Plan offers disease management programs for asthma and diabetes. Members receive education, coaching and other services to help them better manage their condition. Disease management nurses proactively perform or facilitate health risk assessments and develop an action plan based on the member’s understanding of their condition, need for equipment and supplies, referral for specialty care or other special considerations due to co-morbidities, including behavioral health and substance abuse. The programs include interventions focusing on removal of barriers to care, promotion of member adherence to their healthcare treatment plan, lifestyle risk factors, and common self-management skills. All these Condition Management services are managed through the delivery platform to effectively coordinate the care for members with these chronic conditions and risk factors.

Parkland Community Health Plan has an ongoing Quality Assessment and Performance Improvement (QAPI) program that is comprehensive in scope and focuses its attention on the quality of clinical care and services to our members. The program is tailored toward ensuring that members receive preventive healthcare in a timely manner and providing care management to individuals with special healthcare needs. The QAPI program is adherent with State and Federal requirements and overseen by the Governing Board of Directors and Quality Oversight Committees.

Performance improvement and measurement is fundamental to the QAPI program. What cannot be measured cannot be improved. Therefore, it is through analysis of encounter data that Parkland Community Health Plan is able to identify gaps in care and recommend opportunities for improvement. The QAPI program is always seeking provider involvement, feedback and recommendations for improving the delivery of care and services.

Information on Quality Improvement Projects is available upon request.