Partner with Us

Providers

Thank you for choosing to partner with Community First Health Plans.

We look forward to continued collaboration with our provider partners to deliver quality care, improve outcomes, and increase satisfaction for members.

Providers can review all available COVID-19 Vaccine Information and Resources for guidance related to the COVID-19 vaccine.

Welcome, Providers!

Here you will find helpful materials and resources meant specifically for providers and office staff. 

Provider Services Hotline:
(210) 358-6294 and (210) 358-6030 

For after hours assistance, please call 1-800-434-2347.

File a Complaint or Appeal

To file a Provider complaint or appeal, please use the following contact information:

Phone: (210) 358-6294 or (210) 358-6030
Email: nmcfhp@cfhp.com
Fax: (210) 358-6199

Medicaid managed care providers can also submit complaints and inquiries directly to HHSC Managed Care Compliance and Operations (MCCO) via:

Email: HPM_complaints@hhsc.state.tx.us
Fax: (512) 491-1958
Mail:

Health and Human Services Commission Medicaid/CHIP
Managed Care Compliance and Operations
P.O. Box 149030 MC-0210
Austin, TX78714-9030

Prior Authorizations

Information on referrals and prior authorizations required by Community First Health Plans.

CHIP / CHIP Perinatal

The Children’s Health Insurance Program (CHIP) and CHIP-Perinatal Program provides low cost services to children, pregnant woman and unborn children of non-Medicaid eligible women.

STAR Kids

The program is the first Medicaid managed care program specifically for people who are 20 and younger, have a disability, and use Medicaid.

STAR Medicaid

STAR Medicaid is a managed care program for families without health insurance. Families with children on Medicaid pay nothing for healthcare services.

Provider FAQ

Do you have a question? Take a look at some of our most frequently asked questions.

EVV

Electronic Visit Verification

Our Network

Community First Health Plans service areas

Provider Portal

Community First’s Provider Portal is a secure website to verify Member eligibility, submit authorization requests, access a Member’s Individual Service Plan (ISP), and much more.

Provider Manuals

Access all of the Provider Manuals to keep up to date with each health plan.

Members Rights and Responsibilities

Information on Members Rights and Responsibilities including referrals and prior-authorization. 

Provider Resources

Community First Health Plans is glad to partner with our providers to help deliver quality healthcare to our members. Please click here to utilize these resources we have available for you.

STAR+PLUS

The STAR+PLUS Program covers adults who have disabilities or are age 65 or older. 

HHSC Updates

Stay updated with all HHSC news!

PROVIDER INCENTIVES

Community First offers incentives to our network providers.
To see what incentives are currently available, log in to the secure Community First Provider Portal.  

Texas Medicaid/CHIP Vendor Drug Program

Learn more about the Texas Medicaid/CHIP Vendor Drug Program.
You will be able to access Medicaid formularies and preferred drug lists here.  

Provider Enrollment Requirements

 Please update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment on the Portal – A Step-by-Step Guide”.

For instructions on how to make other demographic updates to your current enrollment, please access the document titled “Provider Information Management System (PIMS) User Guide”.

Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.

COMMUNITY FIRST HEALTH PLANS Provider E-NEWSLETTER

Stay up to date on important news and upcoming events.

Can’t find what you need?

Please contact the Provider Hotline at 800-214-4844 from 8:00AM – 5:00PM, Monday – Friday.  

If you are a provider and need to reach CFHP after hours or on weekends, please call (210) 227-2347.

Beginning September 1, 2024 Community First Health Plans, Inc. will be adding STAR+PLUS to its line of health care products.

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