Parkland Community Health Plan (PCHP) — a program of Dallas County Hospital District serving STAR, CHIP, and CHIP Perinate across seven North Texas counties (Dallas, Collin, Ellis, Hunt, Kaufman, Navarro, and Rockwall) — delivers the state Autism Services benefit for members ages 0–20 with an ASD diagnosis made or reconfirmed within 3 years, available on STAR only (CHIP is excluded, matching the statewide rule). The operational fact that matters most for intake right now: PCHP transitioned behavioral health administration away from the Carelon Behavioral Health network and brought it in-house, effective September 1, 2025 — providers who contracted with Carelon for Parkland's BH network had to re-contract directly with PCHP, and older Carelon-branded provider manuals for this plan are no longer current.
PCHP's Prior Authorization Requirements document (effective September 1, 2025) states plainly: "Prior authorization is required for ABA evaluation, initial course of treatment, and subsequent re-evaluations for recertification." Its code table lists 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, and 99366 explicitly under an "Applied Behavior Analysis" category — 0362T does not appear anywhere in the list, and we found no PCHP document addressing that code specifically, so treat its status as unconfirmed rather than assuming it is or isn't required. The document points to a supporting-documentation appendix for code-level specifics that we could not independently verify — confirm current documentation requirements with PCHP provider services before your first submission.[1][2]
PCHP announced it was "transitioning Behavioral Health services from Carelon effective Sept. 1, 2025," with providers required to contract and credential directly with PCHP to remain in-network for behavioral health, and new member ID cards issued with updated BH information. PCHP's own 218-page provider manual, last revised September 2024, still describes "Carelon and PCHP will work together" and contains no ABA-specific content at all — it predates both the transition and any ABA-specific policy detail, so treat it as materially out of date for behavioral health and ABA purposes. The PA requirements PDF and direct contact with PCHP provider services (1-888-672-2277) are the more current sources.[3][4]
Follows the Texas Medicaid rule — Parkland's own provider documents that we checked (October 2026) set no change-of-provider rule of their own. A family that moves to a new ABA provider outside the current group needs a new authorization request with all the documentation of an initial evaluation, plus a change-of-therapy-provider letter signed by the responsible adult giving the date therapy ended (or the last date of service) and the names of both providers (TMPPM § 2.3.9). A move to another provider within the same group keeps the same evaluation, plan of care and authorization period. If the child changes health plans, "Health plan prior authorizations do not automatically transfer," but the new MCO must continue an existing authorization it is told about, at the same amount, duration and scope, until the earliest of 90 days, the end of the authorization, or its own new decision (Managed Care Handbook § 2.8).[5][8]
Joining the network: a provider must be enrolled in Texas Medicaid before an MCO can enroll it; "Individual MCOs and DMOs have their own guidelines for contracting providers," and Medicaid enrollment "does not guarantee that an MCO or DMO will contract enroll or credential a particular provider." All Medicaid MCOs credential through the Texas Association of Health Plans' contracted credentialing verification organization (Handbook § 2.2.1). Parkland does not publish whether its ABA network is open, so ask its provider relations team.[5][8]
HHSC sets the claim clocks for every Texas Medicaid MCO in its Uniform Managed Care Claims Manual: a provider must file a claim with the MCO "within 95 Days from the date of service," and the MCO must deny a claim it does not receive in that window unless an exception applies (wrong plan, other insurance, newborns, newly enrolled providers). The MCO must tell the provider it "has 120 Days from the date of disposition to appeal the Claim," and must adjudicate an appealed claim within 30 days. Its performance standard is to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days, with every claim finalized within 24 months of the date of service. When another insurer is billed first, the claim “must be refiled and received by the MCO within 95 Days from the date of disposition by the other insurance resource.” HHSC sets no weekly submission cutoff or check-run day; each MCO runs its own payment cycle. The TMPPM Managed Care Handbook repeats the 95-day rule and sends appeals to the MCO first, then to HHSC as a complaint.[10][8][11]
Parkland’s 2025 manual: submit clean claims "within 95 calendar days from the date of service for outpatient services," and "A provider has 120 days from the date of an Explanation of Payment (EOP) to file a payment dispute."[10][8][11]
The questions that decide whether a family can start with Parkland Community Health Plan, and what they have to bring. Each maps onto something intake should ask on the first call.
Ages 0-20 for STAR members, per PCHP's own member-facing ABA benefit page; CHIP is excluded, matching the statewide rule.[2][5]
Follows the Texas Medicaid (TMPPM) rule: the ASD diagnosis must be made or reconfirmed within 3 years of initiation or recertification; past 3 years a comprehensive re-evaluation of ASD symptom severity levels per DSM criteria is required first.[5][1]
Follows the Texas Medicaid (TMPPM) rule; PCHP's own member-facing benefit page names a developmental pediatrician, neurologist, psychiatrist or licensed psychologist.[2][5]
Follows the Texas Medicaid (TMPPM) rule: a reliable, valid, standardized diagnostic assessment tool or combination of tools — the manual names the ADOS, ADI-R and CARS as examples. Screening instruments alone (STAT, M-CHAT-R) do not substitute.[5][1]
Follows the Texas Medicaid (TMPPM) rule: a signed, dated prescriber referral for the evaluation, signed within 60 calendar days before or on the anticipated evaluation date; and for treatment a signed, dated referral from a physician or allowed practitioner (MD/DO, PA, NP, or CNS with delegated authority) stating frequency and duration, signed on or before the service start date and no more than 3 months old. Since 4/1/2025 the prescriber signature is no longer required on the CCP PA form for the 90-day extension.[5][1][7]
Follows the Texas Medicaid (TMPPM) rule: synchronous audio-visual only, modifier 95, on 97151, 97155, 97156, 97158 and 99366. One-on-one direct treatment delivered to the child by a behavior technician or LaBA must be in person — telehealth is prohibited for BT/LaBA-delivered direct service.[5][1]
Parkland's table: "Medicaid Routine/Non-Urgent 3 business days | CHIP Routine/Non-Urgent 2 business days (approval) 3 business days (adverse determination) | Medicaid & CHIP Urgent/expedited 3 calendar days," with hospitalized requests within 1 business day and post-stabilization or life-threatening within 1 hour. A request is not expedited when "The date of service is greater than one week from the request date," and "Urgent," "Expedited" or "STAT" labels that do not meet the definition are processed as non-urgent. Incomplete requests: the plan "will notify the requesting provider and member, by phone and in writing, of missing information no later than three (3) business days after the prior authorization receive date"; if nothing arrives in the stated time the medical director decides on what was received. Lead times: initial requests "a minimum of three business days prior to the start of care"; recertifications "at least 60 calendar days prior to the expiration of the current authorization" (the 30-day exception list names only PT/OT/speech, private duty nursing and PPECC — not ABA).[11][1][12]
"Federal and state laws require Medicaid, including the STAR program, be the payer of last resort … Providers must submit claims to other health insurers for consideration prior to billing us. A copy of the other health insurer's EOB/EOP or rejection letter should be submitted with the claim." Deadline: "submit clean claims within 95 calendar days of receiving a response from the third-party payer." Parkland's pay-and-pursue language covers trauma and subrogation cases, not other health insurance. The manual does not say whether Parkland's ABA PA is still needed when it pays second — request it.[11][13]
Coverage decides whether Parkland Community Health Plan pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the Texas Medicaid (TMPPM) rule: the manual sets no numeric ratio of its own, requiring LBAs to directly supervise LaBAs and behavior technicians in accordance with Texas licensure and deferring to the certifying body's minimums — for RBT-credentialed staff the BACB floor of supervision on at least 5% of service hours each month with two face-to-face contacts. Only direct supervision, where the LBA observes the LaBA or BT with the child, is reimbursable (under 97155); indirect supervision is unpaid.[5][1][6]
Follows the Texas Medicaid (TMPPM) rule: concurrent billing is prohibited — Texas Medicaid will not reimburse multiple ABA providers during one session with the child when more than one provider is present. The single exception is when the family and the child receive separate services and the child is not present in the family session. Total authorized hours may be requested under either 97153 or 97155 and billed as the code matching the service actually delivered — not both for the same clock time with the child present.[5][1]
Follows the Texas Medicaid (TMPPM) rule: direct treatment is capped at 8 hours (32 units) per day combined across 97153, 97154, 97155 and 97158; 97151 is capped at 6 hours (24 units) per evaluation and per re-evaluation; group treatment runs 2 to 8 children. TMPPM: “If services billed exceed the limitations outlined in this section, the claim will be denied, and may be appealed,” so the cap is a claim edit as well as an authorization limit. Authorization periods are two consecutive 90-day terms then recertifications of up to 180 days.[5][1]
Follows the Texas Medicaid (TMPPM) rule: rendering ABA providers must sign each entry with full signature and credentials, with additional supervisory signatures per state licensure. Treatment notes carry the child's name, date of service, start and stop times, goals addressed, progress and a summary of interventions; 97155/97158 notes add protocol-modification decision points. The 97151 evaluation and the 90-day progress summary each need a dated signature from the LBA and from the parent or caregiver.[5][1]
Follows the Texas Medicaid (TMPPM) rule: home, clinic, office and community settings are payable. In schools, services delivered by a behavior technician as a shadow, an aide, or as general support are excluded; school personnel participating to coordinate care are not counted as duplicate providers, and interdisciplinary team meetings bill under 99366 against an ABA PA. BT and LaBA direct treatment must be in person in every setting.[5][1]
Follows the Texas Medicaid (TMPPM) rule: only the LBA enrolls in Texas Medicaid and bills. LaBAs and behavior technicians may not enroll — their services go out under the supervising LBA's NPI with the credential modifier identifying who rendered (HO = LBA, HN = LaBA, HM = behavior technician; 97151 takes HO only, 97155/97156/97158 take HO or HN). The LBA must directly employ or contract with every LaBA and BT on the team.[5][1]
Yes — the Texas Medicaid Autism Services benefit for STAR members ages 0-20 with an ASD diagnosis, on TMPPM criteria. CHIP members are excluded.
No — PCHP transitioned behavioral health administration from Carelon to direct in-house administration effective September 1, 2025. Providers had to re-contract directly with PCHP.
97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, and 99366, per PCHP's own Prior Authorization Requirements list (eff. 9/1/2025). 0362T does not appear on that list — its status is unconfirmed.
A new ABA provider outside the current group must file a new authorization with initial-evaluation documentation and a change-of-provider letter signed by the responsible adult (TMPPM § 2.3.9). A new health plan must continue an existing authorization for up to 90 days, or until it ends or the new plan decides.
It does not publish an open or closed status. Enroll in Texas Medicaid first, then apply to the plan; Medicaid enrollment does not guarantee an MCO contract. Ask provider relations.
Ninety-five days from the date of service. HHSC’s Uniform Managed Care Claims Manual sets it for every Texas Medicaid MCO, and Parkland Community Health Plan’s own manual states the same deadline. Claim appeals get 120 days from the disposition date.
HHSC requires every Texas Medicaid MCO to adjudicate 98 percent of clean claims within 30 days of receipt and 99 percent within 90 days.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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