Provider Forms

American Academy of Pediatrics Recommendations For Preventative Pediatric Health Care

CDC Adult Preventative Care Recommendations

Claims Appeal Form

Claims Department Appeal Submission Form

CMS-1500 Form and Instruction Table

Community First Insurance Plans Compliance Plan 2023

Consent to Use Physician Assistant/Nurse Practitioner

Explanation of Payment (EOP)

Medical Record Review Tool

Member Education Request Form

Pre-Authorization Exemption FAQs

Provider Complaint Form

Provider Information Change Form

Provider Request for Member Transfer

Request For Continuity of Care

Suspicious Activity Report (Member)

Suspicious Activity Report (Provider)

Texas Standard Prior Authorization Request Form for Health Care Services

UB 04 Claim Form and Instructions

University Community Care Plan Member ID Card