Category: Provider Resource

Failure to Submit Medical Records

ATTENTION COMMUNITY FIRST PROVIDERS Texas state regulations (Texas Administrative Code §353.502) require MCOs to conduct routine audits of Provider and Member claims to ensure that proper payments are made.   If you receive a request for medical records, return...

Practitioner’s Statement of Need (PSON)

Personal Care Services (PCS) is considered medically necessary when a member requires help with activities of daily living (ADLs), instrumental activities of daily living (IADLs), or health maintenance activities (HMAs) because of physical, cognitive, or behavioral...

Health Advisory: Locally Acquired Malaria Case

The Texas Department of State Health Services (DSHS) has been notified of a case of malaria diagnosed in a Cameron County, Texas resident who has not traveled outside the country or state. The Texas Department of State Health Services (DSHS) has been...

Community First Members affected by severe weather can contact Member Services at 1-800-434-2347 for support. If you have special health care needs and need assistance, please contact your assigned Service Coordinator directly.

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