Background:
On February 21, 2024, Change Healthcare (CHC) experienced a service disruption that continues to impact pharmacy and medical providers. This is a nationwide event. It is essential to support Medicaid providers so they may continue to provide Members with timely access to high-quality care.
Key Details:
The Texas Health and Human Services Commission (HHSC) is providing the following resources for health plans to mitigate the access to care issues caused by this service disruption.
Medical Claims Submissions
As needed, Providers can utilize the forwarded claims process at Texas Medicaid & Healthcare Partnership (TMHP). Through the forwarded claims process, TMHP can forward claims that go directly to Community First, not to a subcontractor. For additional assistance, please contact the Community First Provider Relations department at ProviderRelations@CFHP.com
Pharmacy
Some pharmacies contract with CHC as a switch vendor and cannot process electronic pharmacy point-of-sale claims. Community First will assist Members in locating alternative pharmacy providers, as needed.
Pharmacies can check eligibility using the HHSC Eligibility Verification Portal. The Pharmacy Eligibility Verification Portal is a browser-based application used to obtain a person’s enrollment status, pharmacy benefits, and managed care participation. All Medicaid-enrolled pharmacy providers are eligible to create a free account. More information is available on the VDP website.
Resource:
Pharmacy List – Switch Vendor (attached)
Next steps for Providers:
Providers should share this communication with their staff.
Community First Resources:
https://communityfirsthealthplans.com/provider-newsletter
https://communityfirsthealthplans.com/providers/
Contact:
Email ProviderRelations@cfhp.com or call 210-358-6294.