Claims Appeal Form

Providers have the right to appeal the denial of a claim by Community First Insurance Plans. To file an appeal, Providers should submit the Claims Appeal Form and a copy of the EOP, along with any information related to the appeal.

For more efficient processing, please fill out the Claims Appeal Form electronically using our secure Provider Portal. For assistance navigating the portal or to create an account, please email or call 210-358-6294 to contact our Provider Relations Department.

Forms with inaccurate information will be rejected, and will receive a rejection notification from our Provider Relations Department.

If you prefer to file an appeal by mail, please download, complete, and print our paper Claims Appeal Form and mail it to the address below beginning June 1, 2022:

Community First Health Plans
P.O. Box 240969
Apple Valley, MN 55124

Please note: Appeals submitted without the Claims Appeal Form will be rejected.