External Medical Reviews

External Medical Reviews

Senate Bill 1207 – External Medical Reviews In accordance with Tex. Gov’t.  Code Section 531.024162, as amended by Senate Bill 1207, HHSC is required to contract with an independent review organization (IRO) to perform external medical reviews (EMR) when...

EVV VMUR Updates

On March 28, HHSC requested feedback from MCOs about updating the Electronic Visit Verification (EVV) Visit Maintenance Unlock Request (VMUR) templates. HHSC processed the feedback received from TMHP, EVV vendors and MCOs and decided to add a new option to the...

Community First Partners with Payspan

Community First Health Plans has partnered with Payspan to provide claim reimbursement and remittance advice (EOP) for our Providers. This free service electronically deposits Community First Health Plans provider reimbursement payments to the bank account(s) of your...

Annual Member Survey

How can Community First Health Plans serve you better? How can we help you choose the best health care plan for you and your family? Community First is continuously working to improve our delivery of quality care and service in a safe manner. To reach this goal, we...

New CES Now Live

Community First is committed to providing ongoing information as we move towards the implementation of new Claims Editing Software (CES). On April 1, 2022, Community First will implement a claims pre-payment auditing process that identifies frequent correct coding...

Providers: Public Health Emergency FAQ

Your Patients’ Medicaid Coverage May Be Impacted by the End of the COVID-19 Public Health Emergency Continuous Medicaid Coverage May End Soon Your patients’ Medicaid coverage may be impacted by the end of the COVID-19 federal public health emergency (PHE). Medicaid...
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