Claim Appeals 

A claim appeal is a written request by a provider to give further consideration to a claim reimbursement decision based on the original and or additionally submitted information. The document submitted by the provider must include verbiage including the word "appeal." All claim appeals must be filed within 120 days of date of the Explanation of Payment (EOP).  

View our Claim Appeal Request Process and Form. 
 
An appeal must meet the following requirements: 

  • Submit a copy of the Remit/EOB page on which the claim is paid or denied. 
  • Submit one copy of the Remit/EOB for each claim appealed. 
  • Identify the reason for the appeal. 
  • If applicable, indicate the incorrect information and provide the corrected information that should be used to appeal the claim. 
  • Attach a copy of any supporting documentation that is required or has been requested by Parkland Community Health Plan. Supporting documentation to prove timely filing should be the acceptance report from Parkland Community Health Plan to the provider’s claims clearinghouse. Supporting documentation must be on a separate page and not copied on the opposite side of the Remit/EOB. 

Please submit your appeals and all supporting documentation via: 

  1. Online: Save time and submit your appeal online through our Provider Portal. 
  2. Mail: PCHP Claims Appeals & Complaints 
    P.O. Box 560347 
    Dallas, TX 75356-9005 
  3. Email: PCHPComplaintsandAppeals@phhs.org 
  4. Fax: 1-844-310-1823 

Questions: 

  • HEALTHfirst (STAR): 1-888-672-2277 
  • KIDSfirst (CHIP) or CHIP Perinate: 1-888-814-2352 

The status of an appeal can be viewed on the PCHP Provider Portal or by calling Provider Customer Service. A resolution will be mailed, and a copy will be accessible on the PHCP Provider Portal.

Claim Disputes 

A claim dispute is a claim originally denied because of incorrect coding (would be considered a corrected claim) or missing information (would be considered a resubmission) or that prevents Parkland Community Health Plan (PCHP) from processing the claim. 

The additional information (COB form/corrected claim, etc.) must be submitted in writing by completing a Claims Dispute Form. 

The definition of a "Complaint" is any dissatisfaction, expressed by a complaint orally or in writing to PCHP, about any matter other than an Adverse Benefit Determination. 

Save time and submit your dispute online through our Provider Portal.  

Provider Complaint to HHSC 

You can also file a complaint with HHSC by email. 

Additional Information 

  • For information about claim appeals, please refer to Claims. 
  • For information regarding provider complaints and appeals, please refer to the Provider Manual.