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FALL 2023 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: 2 Provider Town Hall Update 2 Provider Lunch & Learns 4 Changes in Provider Information 5 Pharmacy Corner 6 Value-Added Services 7 Claims 9 Billing Members 10 Requesting a Referral 11 Clinical Practice Guidelines 12 Social Determinants of Health 13 Pay-for-Quality Program 14 EHR Access A Note from PCHP he last few years have been an ever-...
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SPRING 2023 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: 2 PCHP Community Impact 2 The End of the COVID-19 Pulic Health Emergency 3 Provider Lunch & Learns 3 Provider Town Hall 4 PCHP Prior Authorizations 6 Clinical Practice Guidelines 7 Performance Improvement Projects 8 Medical Pay-for-Quality Program 8 Tip Sheets 2023 8 Medical Record Review 9 EHR Access A Note from PCHP t’s almost time to...
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FALL 2022 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: 2 Provider Town Hall 2 CPW: Case Management for Children and Pregnant Women 3 Value-Added Services 5 Billing Members 6 Requesting a Referral 7 Quality Corner 7 Behavioral Health Services 7 Disease Management Program 8 Provider Satisfaction Survey A Note from PCHP n May 2022, Parkland Community Health support, and monitoring for patients betwe...
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SUMMER 2022 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: 2 Medicaid Renewal and the Federal Public Health Emergency 3 Provider Relations Corner 5 Changes in Provider Information 6 Texas Health Steps Benefits 8 Pharmacy Corner 10 Quality Corner 11 Quality Measures A Note from the CEO s we enter the second half of 2022, I’d like Pyx Health mobile app. We were honored to be A to share a few updates o...
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SPRING 2022 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: 2 2021 Recap and 2022 Strategic Focus 3 Changes in Provider Information 4 Provider Town Hall 5 Applied Behavior Analysis (ABA) Therapy 6 Prior Authorizations 7 NEMT Services 7 Medical Record Review 7 HEDIS Provider Tip Sheets 8 Quality Improvement Program 9 Clinical Practice Guidelines 10 Pharmacy Corner A Note from PCHP ow that the new yea...
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FALL 2021 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: 2021 Provider Town Halls page 3 Availability and Accessibility Requirements page 4 Pharmacy Corner page 6 Texas Medicaid Prior Authorization Process page 12 Drug Formulary and Pharmaceutical Procedures page 13 Clinical Practice Guidelines page 15 Vendor Drug Program Continuing Education page 15 Value-Added Services page 16 hank you for your c...
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SUMMER 2021 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this Issue: Provider Portal Forms & Resources page 3 Claims page 4 Prior Authorizations page 5 Quality/NCQA page 7 Pharmacy Corner page 8 Community Engagement page 13 Mark Your Calendar! page 14 s we move into the second half of 2021, I’d like to take a moment A Note from to thank you for being part of Parkland Community Health Plan’s provider netw...
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SPRING 2021 Provider Newsletter Changing the way communities think about healthcare by connecting people to meaningful health and wellness experiences. In this issue: Provider Portal page 3 Claims page 4 Echo Provider Payment Portal and Provider Services, page 5 Health Services page 6 Claims Reconsideration and Appeals and Provider Data page 9 Guidance on Asthma Education and Coverage page 10 Mark Your Calendar and New Website page 11 Beginning this April, Parkland Community Health Plan is embarking on A...
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The Pulse Winter 2020 A Note from Executive Director and CEO, John Wendling In this issue In 2019, Parkland Community Health Plan (PCHP) NEWS YOU CAN USE celebrated our 20-year anniversary. While we Provider Relations. . . . . . . . . . . 2 celebrated, we had the opportunity to remember INTRODUCING where we have been and to think strategically about Justin Skerbetz where we are going. These conversations led to and Nicholas Smith. . . . . . . . . . 3 exciting and significant changes in our day to day ope...
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The Pulse Summer 2020 HEALTH SERVICES UPDATE A Note from CEO, John Wendling Physician As healthcare providers throughout Texas continue to navigate the COVID-19 pandemic, we must provide Satisfaction Survey more support than ever before to the medically The Be In Control Program Physician underserved population in our region. We are making Satisfaction survey is now open and significant investments in staffing and technology available through August 14, 2020. for the health plan to better serve our membe...
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v Fall 2019 Table of Contents Pharmacy Corner........................................2 A “Perfect” Storm … The Triple Threat ...2 Texas Medicaid Coverage of Influenza Vaccine for the 2019-2020 Season ........3 Patient/Provider Info Breach? Keep PCHP in the Know .........................................4 Disaster Awareness ......................................4 Medical Director Corner..........................5 Flu Season Is Coming! Are You Ready? ..5 Synagis Season 2019-2020.......................6 Avail...
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Summer 2019 Table of Contents A Message from John W. Wendling ............ 1 Provider Relations...News You Can Use .... 1 Access to Care Guidelines ............................. 2 Providers and Members May Request Behavioral Health Case Management ...... 3 Help Us Stop Fraud and Abuse .................... 3 Pharmacy Corner ............................................. 3 Pharmacy Lock-In ............................................ 3 Swimmer’s Ear – Drying it Up ....................... 4 Claim Filing Inst...
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v P SpringThe 2019 ulse Table of Contents Pharmacy Corner Pharmacy Corner .............................................1 Identifying and treating Seasonal Affective Dr. Nneka Cos-Okpalla, PharmD, MBA Disorder..................................................................1 Identifying and treating Seasonal Affective Disorder HHSC Clinical Edit Proposals...........................2 Season Affective Disorder (SAD) is a type of depression that appears related to seasonal Texas Standard PA Request Form cha...
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v The Pulse Winter 2018 Table of Contents Important Message - Updating Provider Important Message - Updating Information Provider Information ...........................1 Dr. Nneka Cos-Okpalla, PharmD, MBA It is important for Parkland Community Health Plan (PCHP) to keep our provider Pharmacy Corner ..................................2 network information current. Up-to-date provider information allows PCHP to accurately generate provider directories, process claims and communicate with our Update to 2018...
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Provider Newsletter Fall 2018 Pharmacy Corner Dr. Nneka Cos-Okpalla, PharmD, MBA Pharmacy Cash Payments Below is the policy surrounding a pharmacy’s ability to accept Texas Drug Utilization Review Board cash payments for Medicaid prescriptions when requested by the The Texas Drug Utilization Review Board held its quarterly meeting recipient. on July 27, 2018, to make recommendations for Texas Medicaid • Pharmacists always have the option to deny cash payments, clinical prior authorizations and preferred ...
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v Provider Newsletter Spring 2018 Medical Director’s Corner Dr. Barry Lachman, MD, MPH Vital Data Technology (VDT) — A free tool from PCHP to improve care PCHP contracts with Vital Data Technology (VDT) to provide a tool VDT can deliver the data to a practice in virtually any format (list, to help improve care coordination, access clinically relevant data individual fax, on line). The data can be integrated with an EHR and manage patient needs. VDT gathers clinically relevant data without security risks....