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Looking up Member’s Coverage on the Provider Portal

July 9, 2019

Effective June 1, 2019, Community First Health Plans (CFHP) implemented a new core claim processing platform called QNXT. To facilitate data transfer to the new system, all active Members in the legacy system, Amisys, were terminated on May 31, 2019. Upon transfer, all previously eligible Members were re-activated with a start date of June 1, 2019; however, legacy data was retained to enable Provider access to previous eligibility spans when needed. Moving forward, looking up a Member’s coverage in the HealthX Provider portal for Members enrolled prior to June 1, 2019, there will be two records available per Member, one for the eligibility span ending May 31, 2019 and the other for current record starting June 1, 2019. 

If you have any questions regarding these changes, please contact Manny Monreal, Network Management Provider Relations Representative, at 210-358-6294 or via email at nmcfhp@cfhp.com. 

Thank you, 

Tim Austin 

Director of Network Management

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Below are the step-by-step instructions for looking up a member's coverage in the provider portal:

  • STEP 1: Log into HealthX with your username and password
  • STEP 2: Click on “Member Eligibility” tab

  • STEP 3: For a Medicad Member, go to Dropdown box and select Medicaid number (Please note: For preexisting Members, you will see two records: “Terminated” refers to Member data through May 31, 20119l “Active” refers to Member data from June 1, 2019 and forward). 

  • STEP 4a: Select the “Active” record for current eligibility (ie., from June 1, 2019 forward)

  • STEP 4b: Select the “Terminated” record to view eligibility spans through May 31, 2019

For CHIP and Commercial Members

To look up CHIP Member, select “CHIP Number” from the dropdown button and follow the same process.

To look up a Commercial Member, using their A number, select “Member ID” from the drop-down button and follow the same process.