Provider FAQs
Frequently Asked Questions
WHO FORMS THE PROVIDER OFFICE STAFF ADVISORY COMMITTEE?
The provider office staff advisory committee (POSAC) consists of PCP, specialty, and other provider representatives to discuss and collaborate on issues that have an impact on our Providers and Members. To find out more information about joining the Community First POSAC, please contact Network Management at 210-358-6030.
How do I apply to become a Network Provider?
If you would like to apply to become a Network Provider, please fill out the letter of interest
How can I obtain Provider Relations contact information?
If you would like to obtain Provider Relations Contact information, please call the Provider Services hotline number at (210) 358-6030 or e-mail nm@communityfirsthealthplans.com.
What is the Provider Services hotline number?
The Provider Services hotline number is (210)358-6030.
What should I do if I want to file a complaint or an appeal?
To file a provider complaint or appeal, please use the following contact information:
Contact: 210-358-6294 or (210) 358-6030
Email: nmcfhp@communityfirsthealthplans.com
Fax: (210) 358-6199
State inbox contact: HPM_Complaints@hhsc.state.tx.us
What is Cultural Competency?
Community First Health Plans maintains a comprehensive Cultural Competency plan, which includes education and outreach activities that are culturally sensitive, meet the language and literacy needs of the targeted population, and will work to minimize communication and physical access barriers. The purpose is to effectively provide, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. The manner in which services are provided will recognize value, affirm and respect the worth of the individual and protect and preserve personal dignity.
Community First provider manuals include information regarding provider access to linguistic and interpreter services available through Community First and information regarding bilingual health plan and Member materials available for provider use.
Are members assigned a PCP?
Members are required to select a PCP upon enrollment.
Is there any customer support for the Web Portal?
First-time providers are given a formal training/tour of our Web portal. Contact your provider relations representative for any issues, concerns or question.
How do I apply for access to the Web Portal?
Providers must submit a completed Web portal agreement. Completed agreements will then be assigned a username and password. Contact your provider relations representative to obtain a Web portal agreement.
Can you request on-line authorization / referrals?
You may request on-line authorizations/referrals and may check the status of your request through the AcuExchange System. You must first request access from our Network Management department by calling (210) 358-6030 or (800) 434-2347.
Can you submit claims via the Web portal?
On-line claims submission is now available through the Provider Web Portal under Claim MD. You may now also appeal a claim through the secure Web portal.
What kind of functions can I perform on the Web portal?
Verify member’s eligibility/status, claim status inquiry, EOP inquiry, provider panel rosters, on-line provider search directory, and Texas Health Steps exams (new, due, overdue).
What are Members Rights and Responsibilities?
You can find Members Rights and Responsibilities here.
Where do I obtain current checkup forms?
Checkup forms may be located on the TMHP website, appendix C of the current Medicaid provider manual contains Texas Health Steps forms.
Where can I locate a copy of a member's prescription formulary?
The Pharmacy Benefits page provides more information for UFCP members.
Are members required to have a referral to visit a participating specialist?
A PCP referral may be required for a consultation with a participating network specialist, depending on the physician group. However, the following specialties do not require a referral:
– OB/GYN
– Family Planning
– Behavioral Health
– Vision
What is the process for changing PCP?
Members may change their PCP at anytime by contacting Community First Health Plans Member Services Department at (210) 358-6090.
Where do I obtain current check up forms?
Checkup forms may be located on the TMHP website, appendix C of the current Medicaid provider manual contains Texas Health Steps forms.
Do I need special training or education to perform Texas Health Steps checkups?
Community First Health Plans provides training and education to contracted Texas Health Steps providers, contact your provider relations representative at (210) 358-6190.
What are Members Rights & Responsibilities?
You can find more information here.
Where can I locate a copy of a member's prescription formulary?
The Pharmacy Benefits page provides more information for commercial members.
Are members required to have a referral to visit a participating specialist?
A PCP referral may be required for a consultation with a participating network specialist, depending on the physician group. However, the following specialties do not require a referral:
– OB/GYN
– Family Planning
– Behavioral Health
– Vision
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Didn’t find the answer?
Please call our Provider Hotline at 210.358.6030 or fill the form below to have a representative contact you.