Claim Appeal Form

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 the EOP, along with any information related to the appeal to:

Community First Health Plans
P.O. Box 240969
Apple Valley, MN 55124

Please note: Appeals submitted without the Claim Appeal Form or with inaccurate or incomplete information will be rejected.

*For more efficient processing, Providers are encouraged to complete the Claim Appeal Form electronically via the Community First Provider Portal.