Provider News
Marketplace Grace Periods: Guidance for Providers
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,...
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...
Claims Processing After Retro-Termination for Marketplace Members
Effective June 15, 2026, and applicable to all Community First Marketplace plans, claims for dates of service during a Member's policy grace period that were previously paid may be adjusted or recouped if the Member’s coverage is retroactively terminated due...
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,...
Modifier 26: Correct Use and Coding Guidance for Diagnostic Services (Professional Component)
Community First Health Plans is providing guidance on the appropriate use of Modifier 26 (Professional Component) when billing for diagnostic services. Proper use of Modifier 26 supports accurate claims processing, compliance with CMS billing guidelines, and reduces...