Parkland Community Health Plan has contracted with, and will work in partnership with, Carelon Behavioral Health (Carelon), an Elevance Health company, to manage the delivery of mental health and substance use disorder services for the Children’s Health Insurance Program (CHIP) and the Medicaid State of Texas Access Reform (STAR) program.
Carelon defines "behavioral health" as both acute and chronic psychiatric and substance use disorders as referenced in the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association.
Primary care health providers including physician health providers may offer behavioral health treatment to PCHP members within the scope of their practice and may also recommend that patients seek behavioral health services provided by behavioral health providers. Members do not require referrals in order to access covered behavioral health services. Parkland CHIP and STAR members can also identify participating behavioral health providers by using the online provider directory (https://parklandhealthplan.com/members/provider-directory/), by calling Carelon at 1-800-945-4644 or by calling PCHP Member Services at 1-888-814-2352 and asking for assistance from the Health Services Department.
When assessing PCHP members for behavioral health conditions, primary care health providers must use the DSM-5 multi-axial classifications and other assessment instruments, or outcome measures required by HHSC.
Carelon provides primary care health providers with screening tools and other resource information to use when assessing and/or treating members for behavioral health conditions. This information is available through the PCP Toolkit and can be accessed at https://www.carelonbehavioralhealth.com/providers/resources/provider-toolkit. This toolkit contains a full library of practice-relevant clinical resources around a variety of the most common and complex behavioral health conditions such as anxiety disorders, substance use disorders, mood disorders and other topics such as psychotropic medications and social determinants of health.
All primary care health providers should work closely with behavioral care providers to coordinate care regarding the whole health needs of every member. Numerous resources on coordination of care activities, including release of information templates, are available for immediate and ongoing use through Carelon’s provider toolkit. Participating providers must comply with the Carelon Behavioral Health Clinical Practice Guidelines. Visit the Carelon Behavioral Health website , where you will find a dedicated Behavioral Health Provider Manual.
Carelon Newsletters
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Carelon Training
PCHP Forms & Guides
Carelon has PCHP specific forms and guides to help providers submit claims, authorizations and more.
How to Become a Carelon Provider
Carelon Behavioral Health serves more than 40 million people across all 50 states. They welcome providers' continued commitment to participate in their network and encourage new providers to join them in their mission to help people live their lives to the fullest potential.
Behavioral health professionals and physicians should contact Carelon at 1-888-204-5581 or https://www.carelonbehavioralhealth.com/providers/join-our-network for questions regarding the credentialing or recredentialing process for the STAR Medicaid and CHIP networks.
