Community First Claim Appeal Form (PDF) Providers have the right to appeal the denial of a claim by Community First Health Plans. To file an appeal, Providers should complete the Community First Claim Appeal Form (linked above). Mail the completed form, a copy of...
Effective July 1, 2022, HHSC is removing CHIP co-payment requirements for office visits and residential treatment services for mental health conditions and substance use disorders. If you/your child needs help right away, call toll-free to talk to someone. You do not...
There will be revisions to the Electronic Visit Verification (EVV) Policy Handbook, these revisions will publish and be effective on Sept. 1, 2022. The handbook includes EVV standards and policy requirements for: Program Providers Financial Management Services...
Community First will not be requiring authorization for behavioral health services that are managed by and billed by the patient’s PCP. This is part of the Collaborative Care Model (CoCM). Senate Bill 672, 87th Legislature, Regular Session, 2021 directed HHSC to...
Payers will begin conducting Electronic Visit Verification Usage Reviews for Consumer Directed Services employers for dates of service on and after September 1, 2022. Beginning September 1, 2022, payers will review the EVV Usage Score for CDS employers. The notice...
