As a participating Provider with Community First Health Plans, it is crucial to adhere to our policies regarding Member billing. This notice serves as a reminder of your obligations and our Members’ rights, particularly concerning balance billing practices.
Understanding Balance Billing:
Balance billing is the practice of charging Members for the difference between a Provider’s fee and the amount covered by their insurance plan. By contract, you cannot bill Members for the difference between your normal charge and the payment rate that you negotiated with Community First for rendering covered services.
Key Points to Remember:
- No Balance Billing: Providers are not allowed to bill members for amounts beyond their copayment, coinsurance, or deductible for covered services. This includes any charges denied due to administrative or contractual issues.
- Exceptions: Members may only be billed for non-covered services if a Private Pay Form Agreement is in place, signed by both the Provider and the Member.
Steps to Ensure Compliance
- Verify Eligibility: Always verify the Member’s eligibility before providing services. This can be done through the Community First Provider Portal or the Texas Medicaid & Healthcare Partnership (TMHP) website.
- Review Remittance Advice: Use your remittance advice notices to understand Provider and Member responsibility.
- Correcting Billing Errors: If a balance billing error occurs, stop the collection process immediately. Work with credit reporting agencies to resolve any issues and ensure the Member’s credit record is unaffected.
Need Assistance?
For further guidance on billing practices, refer to the following resources:
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.