Over the past several years, Community First Health Plans has been implementing payment policies that reflect guidelines set forth by industry authorities. Our goal is to process claims consistently and in accordance with best practice standards.
Starting on March 30, 2026, Community First will partner with Cotiviti, a healthcare and retail analytics company, to implement additional enhancements to our claims editing programs that promote correct coding and billing practices. Community First believes that this will enable you and your billing staff to more readily understand our payment/denial of claims given the widespread use of these policies.
After the implementation, you may receive claims denials or payment changes based on these enhanced claim editing concepts on your Explanation of Benefits or electronic remittances. For additional information on the specifics of your claim submission payment decisions, or to file a grievance or appeal, please contact Provider Services at 210-358-6030 or use our online directory to contact your Provider Relations representative directly.
Recent Comments