Upcoming Changes to PCHP’s Behavioral Health Services
What is changing?
Effective September 1, 2025, Parkland Community Health Plan (PCHP) will directly manage behavioral health services for PCHP Medicaid (STAR) and CHIP members.
When is the transition taking place?
Behavioral health services will be managed by Carelon Behavioral Health (Carelon) through August 31, 2025. PCHP will begin managing behavioral health services starting September 1, 2025.
Why is PCHP making this change?
This transition will enable PCHP to fully integrate behavioral health and physical health services. This also simplifies prior authorizations, claim operations and service coordination, which will all occur through PCHP starting September 1, 2025.
How will this affect provider processes?
Beginning with dates of service/dates of admission on or after September 1, 2025, all services currently coordinated through Carelon, such as claims filing and payment, prior authorizations, and Provider Services, will now be coordinated directly by PCHP. More information about working with PCHP, how to register for the Provider Portal, and how to participate in typical health plan operations will be shared with all newly contracted PCHP providers over the next few months.
Which member groups will be affected?
All PCHP Medicaid (STAR) and CHIP members are affected by this transition. We encourage all Carelon providers to contract and credential directly with PCHP to ensure no disruption to member care or treatment.
What should I tell my patients about what they need to do during this transition?
Your patients do not need to do anything at this time. They will continue to have behavioral health benefits before and after the transition. We will be communicating frequently with PCHP members between now and September 1 to ensure they have all the information they need to continue their care with a PCHP-contracted behavioral health provider. We encourage Carelon providers to contract and credential directly with PCHP to help ensure no disruption in care or treatment for PCHP members.
What do I need to do to continue seeing PCHP members?
If you are contracted and credentialed with Carelon, you must directly contract and credential with PCHP to continue as a participating network provider.
- Complete the Prospective Provider Form.
- Email the completed form to PCHP.ContractingDepartment@phhs.org.
What about pending or new prior authorizations for behavioral health services?
Outpatient Services: Prior authorization requests for behavioral health services submitted by August 31, 2025, will be processed by Carelon, even if the dates of service requested extend beyond September 1, 2025. PCHP will honor Carelon’s authorization determinations and dates of service authorized by Carelon prior to September 1, 2025; Carelon and PCHP will work to transfer all authorization records for service dates September 1, 2025, and forward to support a seamless transition for providers. Providers do not need to make a request to PCHP to authorize services that were previously approved by Carelon. Authorization requests for these services received after September 1, 2025, will be processed by PCHP.
Residential / Inpatient Services: Prior authorization requests for inpatient and residential care will be processed by Carelon when the admission date occurs on or prior to August 31, 2025. In this case, Carelon will continue to process both prior authorization and concurrent review authorization requests until the member’s discharge from care or until October 31, 2025, whichever is first. Should members remain in residential or inpatient care past October 31, 2025, authorizations will be transferred to PCHP and PCHP will process continued stay requests for services starting November 1, 2025, forward. All inpatient and residential authorization requests with an admission date on September 1, 2025, or after will be processed by PCHP.
How will claims payment be impacted by this change?
Outpatient Services: Carelon will be responsible for claims processing and reimbursement for all dates of service prior to September 1, 2025, and submitted by December 31, 2025. Claims submitted after December 31, 2025, will need to be submitted to and processed by PCHP. Claims for outpatient services with dates of service on September 1, 2025, and after will be submitted to and processed by PCHP.
Residential / Inpatient Services: Carelon will be responsible for claims processing and reimbursement for inpatient and residential services when the member’s admission date was prior to September 1, 2025; this includes claims for any associated concurrent authorization for dates of service through October 31, 2025. PCHP will take over utilization management and associated claim payment for concurrent reviews extending past November 1, 2025. Carelon will process claims submitted through December 31, 2025; claims submitted after December 31, 2025, will need to be submitted to and processed by PCHP. Any claims for inpatient and residential care with admission dates on or after September 1, 2025, will be the responsibility of PCHP.
Will Carelon or PCHP process clinical and claim appeals?
Providers should appeal clinical and claims decisions with the agency that rendered the determination. Carelon will process any and all complaints and appeals regarding the determinations Carelon rendered for requests, services and/or claims for dates of service/dates of admission prior to September 1, 2025, as long as the appeal is received on or before December 31, 2025. Any appeals submitted on January 1, 2026, or after will be submitted to PCHP. PCHP will process clinical and claim appeals regarding determinations PCHP rendered for services/dates of admission effective September 1, 2025, and later.
Who can I contact if I have questions about the transition?
The PCHP Provider Relations and Network Development team will be glad to assist you. Please contact them at PCHP.ContractingDepartment@phhs.org or call our Provider Services Line:
STAR: 1-888-672-2277
CHIP: 1-888-814-2352
Monday through Friday, 8 am to 5 pm CST
To ensure a seamless transition for both members and providers on September 1, 2025, please follow these immediate next steps:
- Start the credentialing process by completing the Prospective Provider Form in full.
- Email the completed form to PCHP.ContractingDepartment@phhs.org.
- Visit our website for more information on credentialing.