Members enrolled in a Marketplace health plan are responsible for paying their premium each month. Members that do not make their premium payments in a timely manner enter a grace period, which begins with the first month a payment is missed.During the grace period,...
Provider News
Wheeled Mobility Systems: QRP Seating Assessment and Billing Guidance
Community First Health Plans is providing guidance on billing requirements for services performed by a Qualified Rehabilitation Provider (QRP) related to wheeled mobility system and wheelchair seating assessments and fittings. Proper adherence to these billing...
Emergency Preparedness for Hurricane Season: HHSC Provider Guidance
Community First Health Plans is sharing guidance from the Texas Health and Human Services Commission (HHSC) regarding emergency preparedness for the Atlantic hurricane season, which runs from June 1 through November 30. Providers are encouraged to review and update...
TMHP IAMOnline Activation Email Sent June 8 and 15, 2026
Community First Health Plans is sharing important information regarding TMHP IAMOnline account activation for Texas Medicaid providers. TMHP IAMOnline is the new entry point for accessing applications on the TMHP webpage and is required to manage services, access...
Inpatient Claims Exceeding $10 Million – Billing Requirements
Community First Health Plans (Community First) is providing guidance on the proper billing of inpatient claims totaling $10 million or more. To ensure accurate claims processing, inpatient claims that exceed $10 million must be split into multiple submissions (interim...
Modifier 25: Correct Use and Coding Guidance for Preventive and Acute Care Services
Community First Health Plans is providing guidance on the appropriate use of Modifier 25 when reporting evaluation and management (E/M) services performed on the same date as a preventive medical visit. Proper use of Modifier 25 supports accurate claims processing,...
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