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Health Promotion & Wellness

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

2019 Immunization Schedules

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

CFHP Community Resources List

Please visit the following pages for up-to-date resource information.

Community Health Bridge

Aunt BERTHA

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Value-Added Services: STAR Kids

  • A prescription discount card your whole family can use
  • Prenatal gift programs with up to $150 in gift cards*
  • Low-cost dental services for pregnant members*
  • Healthy Expectations Prenatal Program
  • Expectant mommy baby shower with free diaper bag and baby supplies
  • Birthing classes
  • New mommy mingle & advice meetings with free toddler booster seat1
  • Smoking cessation program
  • Asthma kit and Asthma pillow cover
  • Asthma gift programs with up to $20 in gift cards*
  • Help with getting a ride to medical appointments or health classes
  • Diabetes program with up to $50 in gift card incentives*
  • Weight management program
  • Digital media player with health podcast
  • Temporary phone help*
  • $10 gift card for follow-up appointment after leaving behavioral health hospital
  • Online mental health resources
  • Notary Services
  • Home visits for high-risk pregnant women
  • Texas Health Steps program with up to $270 in gift cards*
  • Personal counseling from nurse for asthma, diabetes, pregnancy and behavioral health issues
  • Eight hours of in-home respite care services*
  • $100 specialized therapies allowance
  • Pre-vocational assistance

*Limitations or restrictions may apply. Please call Member Services for more information.

1 Proof of completed well child checkup required.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Value-Added Services: CHIP Perinatal

  • A prescription discount card your whole family can use
  • 24-hour nurse advice line
  • Prenatal gift programs with up to $150 in gift cards*
  • Low-cost dental services for pregnant members*
  • Healthy Expectations Prenatal Program
  • Expectant mommy baby shower with free diaper bag and baby supplies
  • Birthing classes
  • New mommy mingle & advice meetings with free toddler booster seat1
  • Asthma gift programs with up to $20 in gift cards*
  • Help with getting a ride to medical appointments or health classes
  • Diabetes program with up to $50 in gift card incentives*
  • Digital media player with health podcast
  • Temporary phone help*
  • $10 gift card for follow-up appointment after leaving behavioral health hospital
  • Online mental health resources
  • Notary Services
  • Home visits for high-risk pregnant women
  • Personal counseling from nurse for asthma, diabetes, pregnancy and behavioral health issues

*Limitations or restrictions may apply. Please call Member Services for more information.

1 Proof of completed well child checkup required.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Value Added Services: CHIP

  • Enhanced vision benefits
  • A prescription discount card your whole family can use
  • Free sports physicals
  • 24-hour nurse advice line
  • Prenatal gift programs with up to $150 in gift cards*
  • Low-cost dental services for pregnant members*
  • Healthy Expectations Prenatal Program
  • Smoking cessation program
  • Asthma kit and Asthma pillow cover
  • Asthma gift programs with up to $20 in gift cards*
  • Help with getting a ride to medical appointments or health classes
  • Diabetes program with up to $50 in gift card incentives*
  • Adult healthy lifestyle classes
  • Weight management program
  • Digital media player with health podcast
  • Temporary phone help*
  • $10 gift card for follow-up appointment after leaving behavioral health hospital
  • Online mental health resources
  • Notary Services
  • Zumba Classes
  • Bike Safety and Repair Classes
  • Personal counseling from nurse for asthma, diabetes, pregnancy and behavioral health issues 

*Limitations or restrictions may apply. Please call Member Services for more information.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Value-Added Services for STAR Medicaid

Value Added Services: STAR/Medicaid

  • Enhanced vision benefits
  • A prescription discount card your whole family can use
  • Free sports physicals
  • 24-hour nurse advice line
  • Prenatal gift programs with up to $150 in gift cards*
  • Low-cost dental services for pregnant members*
  • Expectant mommy baby shower with free diaper bag and baby supplies
  • Birthing classes
  • New mommy mingle & advice meetings with free toddler booster seat1
  • Newborn & postpartum classes for new fathers
  • Smoking cessation program
  • Asthma kit and Asthma pillow cover
  • Asthma gift programs with up to $20 in gift cards*
  • Help with getting a ride to medical appointments or health classes
  • Diabetes program with up to $50 in gift card incentives*
  • Adult healthy lifestyle classes
  • Weight management program
  • Digital media player with health podcast
  • Temporary phone help*
  • $10 gift card for follow-up appointment after leaving behavioral health hospital
  • Online mental health resources
  • Notary Services
  • Zumba Classes
  • Bike Safety and Repair Classes
  • Home visits for high-risk pregnant women
  • Texas Health Steps program with up to $270 in gift cards*
  • Personal counseling from nurse for asthma, diabetes, pregnancy and behavioral health issues

*Limitations or restrictions may apply. Please call Member Services for more information.

1 Proof of completed well child checkup required.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Emergency Resources and Information

Community First’s Nurse Advice Line:

        Local: (210) 358-3000 or

       Toll-free: 1-800-434-2347

Emergency Preparedness Links:

CPS Outage Map

Emergency Kit

Safe Flood Routes

Protecting Your Home (Flood)

Flood Hazard Areas

Preparedness Guide (Spanish)

Sign-Up to Volunteer for the Red Cross

Flood Insurance Program

Emergency Contacts:

Please call CPS at (210) 353-4357 with any electricity or gas-related questions.

Contact the San Antonio Police Department SAFFE Office with any questions or concerns at:

North: (210) 207-8350

Central: (210) 207-7413

West: (210) 207-0810

Contact the San Antonio Office of Emergency Management for any additional safety concerns at (210) 206-8580.

Contact the Solid Waste Management Department at (210) 207-6428 with any questions.

Contact SAWS with water and sewer emergencies - (210) 704-SAWS

Emergency Shelters: 

Battered Women's & Children's Shelter - Emergency & Transitional, 7911 Broadway, 210-733-8810 

Bethany United Methodist Church - Laundry, shower, meal, 32 degrees or more, 4102 Eisenhower, 210- 655-5473

Family Violence Prevention Service- Women & Children only, 7911 Broadway, 210-930-3669

Haven for Hope - Outdoor overflow only, Prospect Courtyard, 1 Haven for Hope Way, 210-220-2100

Salvation Army Dave Coy Center - Men only, 18 or older, 3 nights without fees; calls or referrals; 8am- 5pm, 226 Nolan, 210-226-2291

Salvation Army Hope Center- Single Women & Families, Calls and Referrals 24/7, Check in at 3:30pm, Married couples, proof req., 521 W Elmira St., 210-352-2000

SAMMinistries - Serve homeless and near-homeless families, 5922 Blanco Rd, 210-979-6188

Seton Home- Pregnant or parenting teens, Homeless or at risk of being homeless, Children under 18, 1115 Mission Rd., 210-533-3504

Strong Foundation Ministries -Single women & families with children, call for appointment, 414 Hackberry, 210-641-4357

San Antonio Rescue Mission - Men only, 18 or older, 907 E. Quincy, 210-222-9736

Additional Resources:

If you have disaster-related requests for food, clothing, evacuation/transportation assistance, or other immediate assistance, please contact the following:

Additional disaster resources are available through the links below.

1. Hurricane Preparedness Tips from DPS

2. Emergency Supply Kit List from DPS

3. What to do Before and During Major Storms

4. Emergency Documents to Prepare

5. Evacuation Routes Across Texas

6. Texas Emergency Preparedness Site for All Information

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Cómo Presentar una Apelación

¿Qué puedo hacer si mi doctor pide un servicio o medicina para mí que está cubierto, pero el plan de salud lo niega o lo limita? 

CFHP puede negar servicios de atención médica o medicinas si no son médicamente necesarios. Un medicamento también se puede negar si:
• El medicamento no trabaja mas bueno que otros medicinas en la lista de medicamentos preferidos de CFHP
• Si hay otra medicina que es similar que hay que tratar primero de que no ha usado antes 

Si no está de acuerdo con la negación, puede pedir por un apelación.

¿Cómo me avisarán si se niegan los servicios? Recibirá una carta avisándole sobre esto. También recibirá una forma de apelación.

¿Cuándo tiene derecho el miembro de pedir una apelación? Puede apelar si no está satisfecho con la decisión. Tmabien puede pedir por una apelación si Community First negó el pago de un servicio por completo o en partes. Solo Llame STAR Medicaid: 1-800-434-2347
Le enviaremos una forma de apelación para llenar y enviar a Community First. 

Sí, podemos ayudarle a presentar una apelación. Si llama para pedir una apelación, le enviaremos una forma de apelación para llenar y enviar a CFHP. Nos tiene que enviar la forma de apelación escrita y firmada para poder empezar el trámite de apelación, a menos que esté pidiendo una apelación acelerada. 

¿Cuál es el tiempo del proceso de apelaciones? Se le enviará una carta dentro de 5 días para informarle que recibimos la apelación. Le enviaremos nuestra decisión por correo dentro de 30 días. Usted tiene el derecho de pedir una extensión de hasta 14 días. 

Si Community First necesita más información, puede que nosotros pidamos la extensión. Si necesitamos una extensión, le avisaremos por escrito. Le daremos la razón del retraso y cómo le ayudará a usted. Usted tiene el derecho de seguir recibiendo los servicios médicos ya aprobados por CFHP mientras tramitamos su apelación si presenta su apelación antes de: 

• 10 días de la fecha en que recibió una carta con nuestra decisión 

• la fecha en que sus servicios médicos serán reducidos o terminados, según indica nuestra carta de decisión. Si no estoy satisfecho con la resolución de mi apelación, ¿puedo pedir una audiencia imparcial ante el estado? Llámenos para pedir una audiencia imparcial ante el estado. Usted puede pedir una audiencia imparcial ante el estado en cualquier momento. Puede ser durante el trámite de apelación de Community First o después del mismo.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Cómo Presentar Una Queja

¿Qué hago si tengo una queja? ¿A quien llamo? ¿Puede ayudarme alguien de Community First a presentar una queja? ¿Cómo presento una queja ante la HHSC una vez que se haya agotado el trámite de queja de Community First? 

Queremos ayudar. Si tiene una queja, favor de llamarnos llámenos STAR Medicaid: 1-800-434-2347 para explicarnos el problema. Un Defensor de Servicios para Miembros de Community First Health Plans puede ayudarle a presentar una queja. Solo llame STAR Medicaid: 1-800-434-2347

Por lo general, podemos ayudarle de inmediato o, a más tardar, en unos días.

O enviar una solicitud por escrito a:

Community First Health Plans
12238 Silicon Drive, Suite 100
San Antonio, TX 78249
Attention: Member Services Resolution Unit

¿Cuánto tiempo tarda en tramitarse mi queja?

Puede presentar una queja ante CFHP en cualquier momento. Le enviaremos una carta dentro de 5 días para informarle que recibimos la queja. Le avisaremos de nuestra decisión dentro de 30 días.

Si recibe beneficios a través del programa STAR de Medicaid, llame a su plan médico primero. Si usted no recibe la ayuda que necesita allí, debe hacer una de las siguientes: 

Presentar Una Queja: 

1) Llame a la Línea de Ayuda de Administración de Casos de Medicaid al 1-866-566-8989 

2) En línea: Formulario de envío en línea 

3) Correo: 

Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, TX 78711-3247

4) Fax: 1-888-780-8099 

¿Que si quiero someter una queja con HHSC, ya que haya agotado el tramite con Community First?

Una vez que haya agotado el trámite de quejas de Community First Health Plans, puede quejarse ante la Comisión de Salud y Servicios Humanos (HHSC) de Texas llamando gratis al 1-866-566-8989. Si quiere hacer su queja por escrito, por favor, envíela a la siguiente dirección: Texas Health and Human Services Commission Health Plan Operations - H-320 P.O. Box 85200 Austin, TX 78708-5200 ATTN: Resolution Services 

Si tiene acceso a Internet, puede enviar la queja por correo electrónico a: HPM_ Complaints@hhsc.state.tx.us. 

Si desea más información sobre el proceso de apelación, haga clic aqui. 

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Cómo Presentar una Apelación

¿Qué puedo hacer si el doctor pide un servicio o medicina para mí que está cubierto, pero Community First lo niega o lo limita? CFHP puede negar servicios de atención médica o medicinas, si no son médicamente necesarios. 

Un medicamento también se puede negar si:
• El medicamento no trabaja mas bueno que otros medicinas en la lista de medicamentos preferidos de CFHP
• Si hay otra medicina que es similar que hay que tratar primero de que no ha usado antes
Si no está de acuerdo con la negación, puede pedir por un apelación. 

¿Cómo me avisarán si se niegan los servicios?
Usted recibirá una carta avisándole de la decisión y una forma de apelación. 

¿Cuándo tengo el derecho de pedir una apelación? ¿Tengo que hacer la petición por escrito? ¿Puede alguien de CFHP ayudarme a presentar la apelación?
Si no está satisfecho con la decisión, usted puede apelar por teléfono o por correo. Envíe la forma de apelación, o llámenos. Un Defensor de Servicios para Miembros le puede ayudar. Solo llame al 210-358-6300 o gratis al 1-800-434-2347. 

¿Cuáles son los plazos del trámite de apelación?
Le enviaremos una carta dentro de 5 días para avisarle que recibimos la apelación. Le enviaremos nuestra decisión por correo dentro de 30 días calendarios. 

¿Qué pasa si los servicios que necesito son para tratar una emergencia o estoy en el hospital?
Si es una emergencia o está en el hospital, usted puede pedir una apelación acelerada. 

¿Qué es una apelación acelerada? Una apelación acelerada ocurre cuando el plan de salud tiene que tomar rápidamente una decisión debido a su estado de salud, y el proceso normal de apelación podría Quejas y Proceso de Apelación 95 www.cfhp.com | (210) 358-6300 poner en peligro su vida o salud. 

¿Cuáles son los plazos de una apelación acelerada?
Si tenemos toda la información necesaria, contestaremos dentro de un día hábil. 

¿Cómo se pide una apelación acelerada? ¿Quién me puede ayudar a presentar una apelación? ¿Tengo que hacer la petición por escrito? 
Llámenos. Nuestros Representates de Servicios para Miembros le pueden ayudar. Su petición no tiene que ser por escrito. 

¿Qué pasa si CFHP niega la petición de una apelación acelerada? Le avisaremos. Su solicitud será transferida al trámite normal de apelación y le enviaremos nuestra decisión dentro de 30 días calendarios. Si no está de acuerdo con la negación, puede pedir por un apelación. 

¿Qué es una Organización Independiente de Revisión (IRO)? Es un grupo de doctores, que no son empleados de CFHP. Un especialista estudiará su apelación y tomará una decisión final. 

¿Cómo pido una revisión de una IRO? Llámenos para pedir la revisión de una IRO. También puede pedirla por escrito. 

¿Cuáles son los plazos de este trámite? Le enviaremos la decisión final dentro de 15 días calendarios de la fecha en que recibimos su petición de la revisión ante una IRO. 

¿Qué sucede si no estoy satisfecho con la decisión definitiva? Si aún no está satisfecho, puede comunicarse con el Departamento de Seguros de Texas (TDI). Comuníquese con el TDI en: 

Texas Department of Insurance
P.O. Box 149104 Austin, TX 78714-9104
1-800-252-3439

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Cómo Presentar Una Queja

¿Qué hago si tengo una queja? ¿A quién llamo? ¿Puede alguien de CFHP ayudarme a presentar una queja? 

Queremos ayudar. Si tiene una queja, por favor, llámenos gratis al 1-800-434-2347 para explicarnos el problema. Un Defensor de Servicios para Miembros de Community First Health Plans puede ayudarle a presentar una queja. Solo llame al 1-800-434-2347. O enviar una solicitud por escrito a:

Community First Health Plans
12238 Silicon Drive, Suite 100
San Antonio, TX 78249
Attention: Member Services Resolution Unit

Además, los miembros de CHIP deben devolver este formulario de queja para presentar una queja por escrito.

Si no estoy satisfecho con el resultado, ¿con quién más puedo comunicarme? 

Si no está satisfecho con la respuesta a su queja, puede quejarse ante el Departamento de Seguros de Texas llamando gratis al 1-800-252-3439. Si quiere presentar la queja por escrito, por favor, envíela a: 

Texas Department of Insurance Consumer Protection
P.O Box 149091 Austin, Texas 78714-9091
Si usted tiene acceso a internet, puede mandar su queja por correo electrónico a http://www.tdi.texas.gov/consumer/complfrm.html.

¿Cuánto tiempo tardará en tramitarse mi queja? Si llama para registrar una queja, le enviaremos una carta dentro de 5 días calendarios de la fecha de su llamada para informarle que recibimos la queja. También adjuntaremos una forma para quejas. 

¿Cuáles son los requisitos y plazos para presentar una queja? Al devolvernos la forma, dentro de 5 días calendarios después de recibirla, le enviaremos una carta para avisarle que la recibimos. Le enviaremos nuestra decisión dentro de 30 días calendarios. 

Envíe su queja a: 

Servicios para Miembros
Community First Health Plans
12238 Silicon Drive, Suite 100 San Antonio, TX 78249

¿Qué hago si no estoy satisfecho con la respuesta a mi queja?
Si usted no está satisfecho con nuestra respuesta, puede presentar una apelación por escrito. Llame a nuestros Defensores para Miembros. Si presenta una apelación sobre la queja, le enviaremos una carta dentro de 5 días calendarios de la fecha de recibo de la apelación para avisarle que la recibimos. 94 www.cfhp.com | (210) 358-6300 Programaremos una audiencia con el Panel de Apelaciones.

¿Tengo el derecho de reunirme con el Panel de Apelaciones? Cinco días calendarios antes de la audición, usted recibirá una carta con información importante sobre su derecho de apelar. Puede comparecer ante el Panel de Apelaciones. Después de la audiencia ante el Panel de Apelaciones, usted recibirá nuestra respuesta. Le enviaremos una carta dentro de 30 días después de la fecha de recibo de la apelación escrita. 

Puede presentar una queja al TDI en cualquier momento.

Si desea más información sobre el proceso de apelación, haga clic aquí.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

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How to File an Appeal

What can I do if my doctor asks for a service or medicine for me that’s covered but CFHP denies or limits it?

CFHP may deny a health care service or medicine, if it is not medically necessary. A medicine can also be denied:

  • If the medicine does not work better than other medicines on the CFHP Preferred Drug List.
  • If there is another medicine that is similar that you must try first that you have not used before.

If you disagree with the denial, you can ask for an appeal.

How will I find out if services are denied?

You will receive a letter telling you about the decision, with an appeal form.

When do I have the right to ask for an appeal? Does my request have to be in writing? Can someone from CFHP help me file an appeal?

If you are not happy with the decision, you can appeal by phone or by mail. Send in the appeal form, or call us. A Member Services Advocate can help you. Just call (210) 358- 6300 or toll free at 1-800-434-2347 or submit a written request at:

Community First Health Plans
12238 Silicon Drive Ste.100
San Antonio, TX 78249
Attention: Resolution Department

What are the timeframes for the appeal process?

We will send you a letter within 5 calendar days to tell you we received your appeal. We will mail you our decision within 30 calendar days.

What if the services I need are for an emergency or I am in the hospital?

For emergencies or hospital admissions, you can request an Expedited Appeal

What is an expedited appeal?

An Expedited Appeal is when the health plan has to make a decision quickly based on the condition of your health, and taking the time for a standard appeal could jeopardize your life or health.

What are the timeframes for an expedited appeal?

If we have all the information we need, we will have an answer within one working day.

How do I ask for an expedited appeal? Who can help me in filing an appeal? Does my request have to be in writing?

Call us. Our Member Service Advocates can help you. Your request does not have to be in writing.

What happens if CFHP denies the request for an expedited appeal?

We will notify you. Your request will be moved to the regular appeal process and we will mail you our decision within 30 calendar days. If you are not happy with the reply to your appeal, you can ask for review by an Independent Review Organization.

INDEPENDENT REVIEW ORGANIZATION PROCESS

What is an Independent Review Organization?

This is a group of doctors, who are not employees of CFHP. A specialist will review your appeal and make a final decision.

How do I ask for a review by an Independent Review Organization?

Call us to request a review by an Independent Review Organization. You can also request it in writing.

What are the timeframes for this process?

We will mail you the final decision within 15 calendar days from when we received your request for an Independent Review Organization.

What if I am not happy with the final decision?

If you are still not happy, you can contact the Texas Department of Insurance (TDI). You can contact TDI at:
Texas Department of Insurance
P.O. Box 149104
Austin, TX 78714-9104 

or 1-800-252-3439

Web:www.tdi.state.tx.us

Email:consumerprotection@tdi.state.tx.us

*Member may file a complaint through the Texas Department of Insurance at any time during this process. 

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

How to File an Appeal

STAR Medicaid/STAR Kids  

What can I do if my doctor asks for a service or medicine for me that’s covered but Community First Health Plans denies it or limits it?

Community First might deny a health care service or medicine if it is not medically necessary. A medicine can also be denied:

  • If the medicine does not work better than other medicines on the Community First Preferred Drug List 
  • If there is another medicine that is similar that you must try first that you have not used before. If you disagree with the denial you can ask for an appeal.

How will I find out if services are denied?

You will receive a letter telling you about this. You will also get an appeal form.

When does a Member have the right to ask for an appeal?

You can appeal if you are not happy with the decision. You may also ask for an appeal if Community First denied payment of services in whole or part. Just call: STAR Medicaid: 1-800-434-2347 STAR Kids: 1-855-607-7827 or send us a written appeal request:

Community First Health Plans
12238 Silicon Drive Ste.100
San Antonio, TX 78249
Attention: Resolution Department

We will send you an appeal form to fill out and send back to Community First.

Can someone from Community First help me file an appeal?

Yes, we can help you file an appeal. If you call to request an appeal, we will send you an appeal form to fill out and send back to Community First. We must receive a signed, written appeal form from you to begin processing your appeal, unless you are requesting an expedited appeal.

What are the timeframes for the appeal process?

A letter will be mailed to you within 5 days to tell you we received your appeal. We will mail you our decision within 30 days. You have the right to ask for an extension up to 14 days. If Community First needs more information, we might ask for an extension. If we need an extension, we will tell you in writing. We will tell you the reason for the delay and how this will help you. You have the right to keep getting any current medical services Community First already approved while we process your appeal if you file your appeal on or before: 

  • 10 days from the date you received our decision letter or
  • The date our decision letter says your medical services will be reduced or end.

What if I am not happy with the answer to my appeal? Can I request a State Fair hearing?

Call us to ask for a State Fair Hearing. You can ask for a State Fair Hearing at any time. It can be during or after Community First’s appeal process.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

How to File a Complaint

CHIP/CHIP Perinatal

What should I do if I have a complaint? Who do I call? Can someone from CFHP help me file a complaint?

We want to help. If you have a complaint, please call us toll-free at 1-800-434-2347 or send a written request to:

Community First Health Plans
12238 Silicon Drive, Suite 100
San Antonio, TX 78249
Attention: Member Services Resolution Unit

to tell us about your problem. A Community First Health Plans Member Services Advocate can help you file a complaint. Just call 1-800-434-2347. Most of the time, we can help you right away or at the most within a few days.

In addition, CHIP members MUST return this complaint form to file a written complaint.

If I am not satisfied with the outcome, who else can I contact?

If you are not satisfied with the answer to your complaint, you can also complain to the Texas Department of Insurance by calling toll-free to 1-800-252-3439. If you would like to make your request in writing, send it to:

Texas Department of Insurance Consumer Protection
P.O Box 149091
Austin, TX 78714-9091

If you can get on the Internet, you can send your complaint in an email to http://www.tdi.texas.gov/consumer/complfrm.html.

How long will it take to process my complaint?

If you call to file a complaint, we will mail you a letter within 5 calendar days from the date you call to tell you we received your complaint. We will also send you a complaint form.

What are the requirements and timeframes for filing a complaint?

After you return the complaint form, we will mail you a letter within 5 calendar days from the date we received your form to tell you we received it. We will mail you our decision within 30 calendar days.

Send your complaint to:

Member Services
Community First Health Plans
12238 Silicon Drive, Suite 100
San Antonio, TX 78249

What if I am not satisfied with the outcome, whom else can I contact?

If you are not happy with our answer, you can file a complaint appeal in writing. Call our Member Services Advocates. If you file a complaint appeal, we will mail you a letter within 5 calendar days from the date we received your form to tell you we received it. We will schedule an Appeal Panel hearing.

Do I have the right to meet with the complaint appeal panel?

Five calendar days before the hearing, you will receive a letter with important information about your appeal rights. You may appear before the Appeal Panel. After the Appeal Panel hearing, we will send you our answer. We will mail the letter within 30 calendar days from when we received your written appeal.

You can file a complaint with TDI at any time.

If you would like more information regarding the appeal process, please click here. 

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

How to File a Complaint

STAR Medicaid/STAR KIDS 

What should I do if I have a complaint? Who do I call? Can someone from Community First help me file a complaint?

We want to help. If you have a complaint, please call Member Services toll-free at: STAR Medicaid: 1-800-434-2347 STAR Kids: 1-855-607-7827 to tell us about your problem. A Community First Health Plans Member Services Advocate can help you file a complaint. Just call: STAR Medicaid: 1-800-434-2347 STAR Kids: 1-855-607-7827 Most of the time, we can help you right away or at the most within a few days.

You may also send us a written complaint request to:

Community First Health Plans
12238 Silicon Drive, Suite 100
San Antonio, TX 78249
Attention: Member Services Resolution Unit

How long will it take to process my complaint? What are the requirements and timeframes for filing a complaint?

You can file a complaint with Community First at any time. We will mail you a letter within 5 days to tell you we received your complaint. Then we will mail you our decision within 30 days.

File a complaint:

If you get benefits through Medicaid's STAR program, call your medical plan first. If you don't get the help you need there, you should do one of the following:

a. Call Medicaid Managed Care Helpline at 1-866-566-8989 (toll free).

b. Online: Online Submission Form (only works in Internet Explorer)

c. Mail: Texas Health and Human Services Commission
Office of the Ombudsman, MC H-700
P.O. Box 13247
Austin, TX 78711-3247

d. Fax: 1-888-780-8099 (Toll-Free)

What if I want to file a complaint with HHSC, once I have gone through the Community First complaint process?

Once you have gone through the Community First Health Plans complaint process, you can complain to the Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989. If you would like to make your complaint in writing, please send it to the following address: Texas Health and Human Services Commission Health Plan Operations - H-320 P.O. Box 85200 Austin, TX 78708-5200 ATTN: Resolution Services.

If you can get on the Internet, you can send your complaint in an email to HPM_Complaints@hhsc.state.tx.us.

If you would like more information regarding the appeal process, please click here.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

EVV Compliance Score

Effective April 1: EVV Compliance Score Must be 90%

Beginning April 1, 2017, providers required to use Electronic Visit Verification (EVV) will be required to meet the minimum EVV compliance score of 90% as outlined in the EVV Provider Compliance Plan.

Providers were required to meet the minimum score of 75% for the first year of compliance from April 1, 2016, through March 31, 2017.

Questions about this alert can be sent to: CFHPEVV@cfhp.com

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Value-Added Services

Community First Health Plans (CFHP) is happy that you are part of our health plan. The CFHP network of doctors and providers can help you get the care you need. We are the only non-profit, locally owned health plan available to you. As a member of our plan, CFHP offers you extra health care benefits. 

  • Free baby car seat, toddler booster seat or safe sleep play yard
  • Enhanced vision benefits with up to $125 for frames or $75 for contact lenses
  • Free smart phone with up to 500 minutes including unlimited text and 1GB of data
  • Free sports physicals
  • 24-hour nurse advice line
  • Prenatal gift programs with up to $150 in gift cards*
  • Low cost dental services for pregnant members*
  • Mommy & Me baby shower with free diaper bag and baby supplies
  • Zumba classes with free fitness giveaway.
  • Birthing classes
  • Smoking cessation program
  • Asthma kit and Asthma pillow cover
  • Help with getting a ride to medical appointments or health classes
  • Adult Healthy lifestyle classes
  • Weight management program for members ages 7-13 with free membership to the YMCA*
  • $10 gift card for follow-up appointment after leaving behavioral health hospital
  • Online mental health resources*
  • Bike safety and repair classes
  • And more!

*Limitation or restrictions may apply. Please call Member Services for more information at 1-800-434-2347. 

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

CHIP Cost Sharing

The following table includes maximum CHIP cost sharing amounts. If the MCO and the provider have negotiated a lesser amount for a benefit than the identified co-payment, then the co-payment must be capped at the lesser amount.

The following examples are provided for illustrative purposes only.

Example 1: The MCO and a provider have negotiated a $23.00 rate for an office visit. If the Member’s family income is 185% FPL, the co-payment will be capped at $20.00.

Example 2: The MCO and a pharmacy provider have negotiated a $9.30 total reimbursement (dispensing fee + product cost) for a prescription of 800mg of Ibuprofen, 50 tablets. If the Member’s family income is 185% FPL, the co-payment will be capped at $9.30. 

Co-payments do not apply, at any income level, to:

1. well-baby and well-child care services, as defined by 42 C.F.R. §457.520;
2. preventative services, including immunizations;
3. pregnancy-related services;
4. Native Americans or Alaskan Natives;
5. CHIP Perinatal Members (Perinates (unborn children) and Perinate Newborns). 

An MCO is not responsible for payment of unauthorized non-emergency services provided to a CHIP Member by an out-of-network provider. In such circumstances, the CHIP Member will be responsible for all costs.

                CHIP Cost-Sharing


Effective January 1, 2014
Enrollment Fees (for 12-month enrollment period):
Charge
At or below 151% of FPL*
$0
Above 151% up to and including 186% of FPL $35
Above 186% up to and including 201% of FPL $50
Co-Pays (per visit)
At or below 151% of FPL Charge
Office Visit $5
Non-Emergency ER
$5
Generic Drug $0
Brand Drug $5
Facility Co-pay, Inpatient
$35
Cost-sharing Cap
5% (of family’s
income)***
Above 151% up to and including 186% FPL Charge
Office Visit (non-preventative) $20
Non-Emergency ER
$75
Generic Drug $10
Brand Drug $35
Facility Co-pay, Inpatient (per admission)
$75
Cost-sharing Cap
5% (of family’s
income)***
Above 186% up to and including 201% FPL
Charge
Office Visit (non-preventative) $25
Non-Emergency ER
$75
Generic Drug $10
Brand Drug $35
Facility Co-pay, Inpatient (per admission)
$125
Cost-sharing Cap
5% (of family’s
income)***

*The federal poverty level (FPL) refers to income guidelines established annually by the federal government.
*** Per 12-month term of coverage.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Non-Discrimination Notice

Community First Health Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, or sexual orientation.

Community First Health Plans provides free aids and services to people with disabilities to communicate effectively with our organization, such as:

• Qualified sign language interpreters

• Written information in other formats (large print, audio, accessible electronic formats, and other written formats)

Community First Health Plans also provides free language services to people whose primary language is not English, such as:

• Qualified interpreters
• Information written in other languages

If you need these services, please contact Community First Member Services at 1-800-434-2347.

If you believe that Community First Health Plans has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you may file a grievance in person or mail with the director of Compliance at:

Laura Ketterman
12238 Silicon Drive, Suite 100
San Antonio, Texas 78249

You may also file a grievance by phone, fax or email at:

(210) 510-2482

TTY number: 1-800-390-1175

Fax: (210) 358-6014

E-mail: lketterman@cfhp.com

You may also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf. You may also file a complaint by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201

Phone: 1-800-368-1019

1-800-537-7697 (TDD)

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-434-2347 (TTY: 1-800-390-1175).

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-434-2347 (TTY: 1-800-390-1175).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-800-434-2347(TTY:1-800-390-1175)。

주의: 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다. 1-800-434-2347 (TTY: 1-800-390-1175)번으로전화해주십시오.

رقم 1-800-434-2347 قمبراتصلبالمجان. لكفتتویةاللغوعدةالمساخدماتفإناللغة،اذكرتتحدثكنتإذاملحوظة: 1-800-390-1175 :والالصمھات

کال۔ہیںدستیابمیںمفتخدماتکیمددکیزبانکوآپتوہیں،لتےبودوارآپاگردار: خبر 1-800-434-2347 (TTY: 1-800-390-1175) ک

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika

nang walang bayad. Tumawag sa 1-800-434-2347 (TTY: 1-800-390-1175).

ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.

Appelez le 1-800-434-2347 (ATS : 1-800-390-1175)

ध्यानद: यदआपहदीबोलतेहतोआपकेिलएमुफ्तमभाषासहायतासेवाएंउपलब्धह। 1-800-434-2347 (TTY: 1-800-390-1175) परकॉलकर।

توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما

تماس بگیرید. 1-800-434-2347 (TTY: 1-800-390-1175) فراهم می باشد. با

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-800-434-2347 (TTY: 1-800-390-1175).

ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-800-434-2347 (TTY: 1-800-390-1175) पर कॉल करें।

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-434-2347 (телетайп: 1-800-390-1175).

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。1-800-434-2347(TTY:1-800-390-1175)まで、お電話にてご連絡ください。

ໂປດຊາບ: ຖ້າວ່າທ່ານເວົ້າພາສາລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-800-434-2347 (TTY: 1-800-390-1175).

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

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Electronic Visit Verification (EVV)

MEDsys Transition-First Notice March 21, 2018

Fall 2017 Roadshow

Compliance Rate, Effective April 1 

Electronic Visit Verification - HHSC Website Link

STAR Kids Electronic Visit Verification (EVV) Guidelines

*Disclaimer: Guidelines are subject to updates from HHSC.

EVV Quick Facts 

HHSC EVV Reason Codes

EVV RC - FAQ's

EVV Forms and Handbooks

CFHP Provider Compliance Visit Maintenance

HHSC Alerts 

HHSC Seeking Feedback on EVV Vendor Software and Customer Service 

Stakeholders have until April 25 to take a brief survey on their EVV vendor software system and customer service experience. Responses are voluntary and confidential. Feedback received will help identify areas of improvement and training needs.

For any questions regarding EVV, please call 855-607-7827 x5 or 210-358-6403 x5 or email CFHPEVV@cfhp.com.

  • HHSC STAR Kids EVV implementation is November 1, 2016 for:
    • Personal Care Services
    • In-home Respite Services
    • Flexible Family Support Services
    • Community First Choice (CFC) personal care services and habilitation (PCS/HAB)
    • EVV is mandatory for STAR Kids members who select:

         Agency Model

    • EVV is optional for STAR Kids members who selected:

              Consumer Directed Services (CDS)

              Service Responsibility Option (SRO)

EVV Vendor Support:

Data Logic (Vesta) Software, Inc.
Vesta EVV Tech Support 
Email: support@vesta.net
Vesta EVV Training
Email: info@vestaevv.com
1-844-880-2400

MEDsys Software Solutions, LLC 
Texas Dedicated Support:
(877) 698-9392

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

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Envíos a servicios, Autorizaciones, Continuidad de Cuidado

Envío a Servicios

CFHP no requiere de un envío a servicios para ver a un especialista, pero algunos especialistas y consultorios de PCP’s requieren y/o prefieren tener un “envío a servicios” formal. Usted debe consultar con su PCP para confirmar si el especialista necesita un envío a servicios del PCP para que usted pueda ser visto.

CFHP puede asistir al miembro trabajando con el consultorio del PCP y del especialista para comunicar cualquier información necesaria que el uno o el otro proveedor pueda necesitar.

Si el especialista no está dentro de la red, CFHP va a tratar de reclutar al proveedor. Una carta de acuerdo (LOA) / Acuerdo de caso individual puede ser firmado por el proveedor si es necesario. Estos LOA / Acuerdos de casos individuales pueden ser para una o varias visitas y períodos de tiempo.

Autorizaciones

CFHP necesita la autorización de algunos servicios antes de hacerlos. El proveedor llamará a CFHP para solicitar los servicios. Ellos proporcionarán la información sobre su caso médico. Usteddebe consultar con su proveedor para ver si es necesario una autorización.Usted debe preguntar si tienen la aprobación antes de que los servicios se lleven a cabo.

Continuidad de Cuidado

  • 1.Las autorizaciones existentes para los servicios de atención grave (como la terapia ocupacional, física, o del habla) se honrarán durante seis meses después del 1 de Noviembre, de 2016, hasta que la autorización expire, o hasta que el plan de salud conduzca una nueva evaluación.
  • 2.Las autorizaciones existentes para servicios a largo plazo y deapoyo (como servicios privados de enfermería ycuidado personal) se honrarán durante seis meses después del1 de Noviembre de 2016 o hasta que el plan de salud conduzca una nueva evaluación.
  • 3.Usted puede seguir viendo a proveedores no médicos donde usted tiene una relación existente con aquel proveedor, aun si ellos están fuera de la red y/o del área de servicio de Bexar, durante seis (6) meses después del 1 de noviembre de 2016. La autorización (es) para nuevos servicios puede ser requerida según el servicio o procedimiento realizado.
  • 4.Usted puede continuar consultando al médico y especialista donde se tiene una relación existente de cuidado primario o médico especialista, incluso si están fuera de la red y / o fuera del área de servicio de Bexar, durante un máximo de doce (12) meses después del1 Noviembre de 2016, sin necesidad de una autorización para pagar el reclamo del proveedor.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

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Referrals, Authorizations, Continuity of Care

Referrals

CFHP does not require a referral to see a specialist. Some specialists and PCP offices require or prefer to have a “Referral.” You should ask your PCP to confirm with the specialist if a referral is needed from the PCP for you to be seen.

If the specialist is not in-network, CFHP will try to recruit the provider. A Letter of Agreement (LOA)/Single Case Agreement can be signed by the provider if needed. These LOA/Single Case Agreements can be for one or several visits and lengths of time.

Authorizations

CFHP needs authorization for some services before they are done. The provider will call CFHP to request the services. They will provide the information about your medical case. You should check with your provider to see if an authorization is needed. You should ask if they have the approval before the services are done. 

Continuity of Care

1.Existing authorizations for acute care services (like physical, occupational, or speech therapy) will be honored for six months after November 1, 2016, until the authorization expires, or until the health plan conducts a new assessment.

2.Existing authorizations for long-term services and supports (like private duty nursing and personal care services) will be honored for six months after November 1, 2016 or until the health plan conducts a new assessment.

3.You may continue to see non-physician providers where you have an existing relationship with that provider, even if they are out of network and/or out of the Bexar Service Area, for up six (6) months after November 1, 2016.Authorization(s) for new services may be required depending on the service or procedure being performed.

4.You may continue to see physician and specialists where you have an existing relationship with that primary care or specialist physician, even if they are out of network and/or out of the Bexar Service Area, for up to twelve (12) months after November 1, 2016 without need for an authorization to pay the provider’s claim.

Continuity of Care-Reminder to STAR Kids Members

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

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Pharmacy Benefit Manager

Pharmacy

Navitus Health Solutions is the Pharmacy Benefits Manager for CFHP.

Navitus maintains the drugs that require prior authorizations, Prior authorization criteria logic, Supporting tables, Clinical publications and sources relevant to the clinical edit, Publication history.

https://www.navitus.com/texas-medicaid-star-chip/Clinical-Edits.aspx

Information must be accurate and up-to-date. Examples of these categories of information are located on the Texas Vendor Drug Program website:

http://www.txvendordrug.com/dur/edits.shtml

CFHP maintains prior authorization for Clinical Administered Drugs (CAD) criteria. Below is the criteria for CAD drugs authorizations:

Pharmacy Prior Authorizations

Authorization Requirements - STAR Kids - Effective November 1, 2016

Authorization Requirements - STAR, CHIP, HMO, Exchange - Effective January 1, 2016

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Transparency in Coverage

Below is information about your Community First Health Plans coverage including claims information, prior authorization and additional information. For a full review of your benefits and coverage, please refer to your Evidence of Coverage and Schedule of Benefits.

Below is information about your Community First Health Plans coverage including claims information, prior authorization and additional information. For a full review of your benefits and coverage, please refer to your Evidence of Coverage and Schedule of Benefits.

Out-of-network liability and balance billing

Except for emergency services, you should always access healthcare services through providers that are in our network. Coverage from out-of-network providers is not a covered benefit, unless if you have a true medical emergency. If you need to see an out-of-network provider due to an emergency, you will need to let us know as soon as you are able to and will need to arrange any follow-up care with your PCP.

If you receive care from a non-participating provider for an emergency, your copayment and deductible will not change. If you access care from a non-participating provider that is not considered a true medical emergency, you will be financially responsible for any and all payments.

When receiving care at one of our participating hospitals or emergency rooms, it is possible that some hospital-based providers (for example, anesthesiologists, radiologists, pathologists) may not be under contract with us as participating providers. These providers may bill you for the difference between our allowed amount and the provider’s billed charge — this is known as "balance billing." We encourage you to inquire about the providers who will be treating you before you begin your treatment, so you can understand their participation status with us.

Enrollee Claim Submission

When you receive medical treatment from a Community First participating provider, there are no claim forms to complete and no bills to submit. You are responsible for your copayment(s) and/or coinsurances(s) at the time services are rendered. You should not get a bill from Community First or First Health participating providers for covered services.

Providers will typically submit claims on your behalf, but sometimes you may have to pay for a covered service and file a claim for reimbursement. This may happen if:

  • Your provider is not contracted with us.
  • You have an out-of-area emergency.

If you have paid for services we agreed to cover, you can request reimbursement for the amount you paid, less any deductible, copayment or cost sharing that is your financial responsibility.

To request reimbursement for a covered service, you need a copy of the detailed bill from the provider who provided the services. You also need to submit an explanation of why you paid for the covered services. Send this to us at the following address:

Community First Health PlansAttn: Claims Department
12238 Silicon Drive, Ste. 100
San Antonio, TX 78249

After getting your claim, we will let you know we have received it, begin an investigation and request all items necessary to resolve the claim. We will do this in 15 days or less.

We will notify you, in writing, that we have either accepted or rejected your claim for processing within 15 days after receiving all items necessary to resolve your claim. If we accept your claim, we will make payment within 5 business days after notifying you of the payment of your claim. If we reject your claim, we will give you the reason your claim is rejected. If we are unable to come to a decision about your claim within 15 days, we will let you know and explain why we need additional time, and will make our decision to accept or reject your claim no later than the 45th day after our notice about the delay.

Grace Periods and Claims Pending

If you don’t pay your premium by its due date, you’ll enter a grace period. This allows you extra time to pay.

During your grace period, you will still have coverage. However, if you don’t pay before a grace period ends, you run the risk of losing your coverage. During a grace period, we may hold — or pend —payment of your claims. If your premium is not brought current by the end of your grace period, you may be held responsible for services provided to you during that time.

If your coverage is terminated for not paying your premium, you won’t be eligible to enroll with us again until Open Enrollment or a Special Enrollment period. 

If you receive a subsidy payment

After you pay your first bill, you have a three-month grace period. During the first month of your grace period, we will keep paying claims for covered services you receive. If you continue to receive services during the second and third months of your grace period, we may hold these claims. If your coverage is in the second or third month of a grace period, we will notify you and your healthcare providers about the possibility of denied claims. We will also notify the U.S. Department of Health and Human Services (HHS) that you haven’t paid your premium.

If you don’t receive a subsidy payment

After you pay your first bill, you have a grace period of one month. During this time, we will continue to cover your care, but we may hold your claims. We will notify you, your providers and the HHS about this non-payment and the possibility of denied claims.

Retroactive Denials

There are instances where claims are received and paid due to the member showing active in the claims system, however, the member should have been terminated. When this happens Community First requests recoupment of payment from the Provider.

Reasons for termination can be untimely payment of premiums, late notification of other coverage, or a change in circumstance, such as divorce or marriage.

If the member feels that the termination is in error, they should contact our Member’s Services department.

Recoupment of Overpayments

Members may call in to request a refund of overpaid premium. Refunds are processed by a manual check. Refunds may take up to two weeks for processing.

Prior Authorization

Some covered service expensesrequire prior authorization. This is to ensure that the requested services are covered by your benefit plan and that they are being rendered in an appropriate setting. Typically, your PCP or treating provider will contact Community First to request the services and will provide the necessary information related to your case. However, as a member of Community First, you also have a responsibility to make sure your provider has requested authorization for certain services. If services are received prior to obtaining authorization, you may be held financially responsible for payment of claims that are denied to the provider. Some of those services include, but are not limited to:

1. Ambulatory/outpatient surgical procedures
2. Behavioral health/chemical dependency services
3. Hospital/inpatient admissions
4. Imaging services
5. Medications (injectable drugs over $500, excluding chemotherapy drugs)
6. Nursing services (private duty nursing and home health services)
7. Out of network services
8. Pain management services
9. Supplies/medical equipment
10. Telemedicine/telehealth services
11. Therapy services
12. Transplants
13. Transportation (ambulance/air transport for non-emergent hospital transportation)
14. Wound care
15. Other services and tests (genetic testing and nutritional supplements/formulas)

Prior authorization requests should be submitted to Community First by phone/efax/Provider portal as follows:

1. At least 5 days prior to an elective admission as an impatient in a hospital, extended care or rehabilitation facility, or hospice facility.
2. At least 30 days prior to the initial evaluation for organ transplant services.
3. At least 30 days prior to receiving clinical trial services.
4. At least 5 days prior to a scheduled inpatient behavioral health or substance abuse treatment admission. 
5. At least 5 days prior to the start of home health care.

After prior authorization has been requested and all required or applicable documentation has been submitted, we will notify you and your Provider if the request has been approved as follows:

1. For immediate request situations, within 1 business day, when the lack of treatment may result in an emergency room visit or emergency admission.
2. For urgent concurrent review within 24 hours of receipt of the request.
3. For urgent pre-service, within 72 hours from date of receipt of request.
4. For non-urgent pre-service requests within 3 calendar of receipt of the request.
5. For post-service requests, with in 30 calendar days of receipt of the request.

 Failure to Obtain Prior Authorization

Failure to comply with the prior authorization requirements may result in benefits being reduced or not covered.

Network providers should not bill you for services for which they fail to obtain prior authorization as required.

In the event of an emergency, no prior authorization is required, however, you must contact us as soon as reasonably possible after the emergency occurs to receive authorization for the emergency procedures in order for payment to be processed.

Drug Exceptions Timeframes and Enrollee Responsibilities

Standard exception request

An enrollee, an enrollee’s representative or an enrollee’s prescriber may request a standard review of a decision that a drug is not covered by the plan.The request can be made orally or in writing. If the request is submitted in writing, use the Exception to Coverage Request form (see attached document). You can also fill out the form and submit it electronically through the Navitus Member Portal (hyperlink to https://members.navitus.com/en-US/Session/Secured-Pages/Home.aspx). You may need to send attachments. If so, please fax or mail the form with additional information you need to include. If you need a hard copy of the form sent to you, call the phone number on the back of your Member ID card. You may also ask us for a coverage determination by phone. To do this, call the phone number on the back of your Member ID card.

Within 72 hours of the request being received, we will provide the enrollee, the enrollee’s designee or the enrollee’s prescribing provider with our coverage determination. Should the standard exception request be granted, we will provide coverage of the non-formulary drug for the duration of the prescription, including refills.

Expedited exception request

An enrollee, an enrollee’s representative or an enrollee’s prescriber may request an expedited review based on urgent circumstances. Urgent circumstances exist when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee's life, health, or ability to regain maximum function or when an enrollee is undergoing a current course of treatment using a non-formulary drug.

Within 24 hours of the request being received, we will provide the enrollee, the enrollee’s representative or the enrollee’s prescriber with our coverage determination. Should the expedited exception request be granted, we will provide coverage of the non-formulary drug for the duration of the exigency.

External exception request review

If we deny a request for a standard exception or for an expedited exception, the enrollee, the enrollee’s representative or the enrollee’s prescriber may request that the original exception request and subsequent denial of such request be reviewed by an independent review organization. We will make our determination on the external exception request and notify the enrollee, the enrollee’s representative or the enrollee’s prescriber of our coverage determination no later than 72 hours following receipt of the request, if the original request was a standard exception, and no later than 24 hours following its receipt of the request, if the original request was an expedited exception. If we grant an external exception review of a standard exception request, we will provide coverage of the non-formulary drug for the duration of the prescription. If we grant an external exception review of an expedited exception request, we will provide coverage of the non-formulary drug for the duration of the necessity.

Information on Explanations of Benefits

An explanation of benefits (EOB) is a statement that we send to members to explain what medical treatments and/ or services we paid for on behalf of a member. This shows the amount billed by the provider, the issuer’s payment, and the enrollee’s financial responsibility pursuant to the terms of the policy. We will send an EOB to a member after we receive and adjudicate a claim on your behalf from a provider. If you need assistance interpreting your Explanation of Benefits, please contact Member Services at 1-888-512-2347.

Coordination of Benefits

The Coordination of Benefits (COB) provision applies when a person has healthcare coverage under more than one plan. Plan is defined below.

The order of benefit determination rules govern the order in which each plan will pay a claim for benefits. The plan that pays first is called the primary plan. The primary plan must pay benefits in accord with its policy terms without regard to the possibility that another plan may cover some expenses. The plan that pays after the primary plan is the secondary plan. The secondary plan may reduce the benefits it pays so that payments from all plans equal 100 percent of the total allowable expense.


Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

STAR Kids for Members

TexasStarKIDS Logo FINAL1.JPG Call Today: 210-987-8113


Beginning November 1, 2016, Community First Health Plans will provide health care for children and youth who receive disability-related Medicaid in the Bexar service delivery area. The program is the first Medicaid managed care program specifically for people who are 20 and younger, have a disability, and use Medicaid.

The STAR Kids Program will cover children and youth ages 20 and younger who receive Supplemental Security Income-related Medicaid, live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility, or are enrolled in a home and community based services waiver program including:

  • Medically Dependent Children Program (MDCP)
  • Home and Community-based services (HCS)
  • Community Living Assistance and Support Services (CLASS)
  • Deaf Blind with Multiple Disabilities (DBMD)
  • Texas Home Living (HxHmL)
  • Youth Empowerment Services (YES)

Program Benefits and Services

STAR Kids is designed to meet the unique needs of children and youth with disabilities. The program will include access to benefits such as:

  • Prescription drugs
  • Hospital care
  • Primary and specialty care
  • Preventive care
  • Personal care services
  • Private duty nursing
  • Durable medical equipment and supplies
  • MDCP services

Children who receive Medicare will keep using Medicare for basic health services and prescriptions ordered by their doctor. Families will receive assistance with coordinating care. Community First Health Plans will provide service coordination, which will help identify needs and connect members to services and qualified providers. Community First’s service coordinators will assess each member’s specific needs to help the family and health plan create a unique individual service plan. Service coordinators will provide a standard screening and assessment, STAR Kids Screening and Assessment (SK-SAI), to determine each child’s needs as they relate to health and independent living.

Member Handbook


Find a Provider


FAQs

Service Coordinator Lookup (coming soon)


Service Area

Community First’s STAR Kids service area includes the following counties: Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

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Commercial Member Rights & Responsibilities

Member Rights

Community First is your partner in managing your health. This partnership is built upon cooperation, with rights and responsibilities for both Community First staff and our members.

Your Rights

As a member you have the right to:

Receive information about our organization, our services, our practitioners and providers, and member rights and responsibilities.

Be treated courteously and in a manner that respects your right to privacy and dignity in a non-discriminatory manner.

Have these rights and responsibilities explained to you by Community First and receive a copy of this handbook in another format, if needed, due to a visual or other disability.

Understand how to access Community First’s health care benefits as well as select and be assigned to a Community First PCP within 30 calendar days of enrollment.

Receive prompt, courteous and appropriate medical treatment, without physical or communication barriers.

Participate in and understand your health conditions, recommended treatment, alternate treatment available, the risks involved, how to care for yourself to maintain optimum health, and to request a second opinion through Community First.

  • Have a discussion of appropriate or medically necessary treatment options, regardless of cost or benefit of coverage.
  • Consent to treatment unless a life-or limb-threatening emergency exists, and establish advanced directives as permitted under federal and state laws and have someone not directly involved in your care be present during your examination or treatment.
  • Review your records and have your records treated with privacy and confidentiality.
  • Take part in available wellness programs.
  • Suggest how we can improve our services to you and other members.
  • File a complaint or appeal a decision made by Community First in accordance with Community First procedures.
  • Make recommendations regarding Community First’s member rights and responsibilities policy.

Member Responsibilities

Your Responsibilities

As a member, you have the responsibility to:

  • Read this member handbook to learn how Community First works and your Certificate of Coverage to understand your health plan benefits, limitations, and exclusions.
  • Carry your Community First member ID card with you at all times while enrolled.
  • Appropriately use your health plan.
  • Use only Community First PCPs, use participating specialists when referred by your PCP, except OB/Gyn and Behavioral Health, and obtain services at a Community First Health Plans contracted facility.
  • Advise Community First as soon as possible whenever you receive care from a provider outside Community First’s network, whether inside or outside the service area.
  • Establish a positive and collaborative relationship with your physician, schedule appointments for routine care, keep scheduled appointments and arrive on time, and promptly contact your provider when you are unable to keep an appointment.
  • Give your provider complete and accurate information and help providers obtain your medical records.
  • Cooperate with the treatment instructions you and your health care provider agree upon.
  • Understand your health problems and participate in developing mutually agreed-upon treatment goals, to the degree possible.
  • Additionally, communicate to your physician any concerns that you or your family members have about your health or health care.
  • Adopt personal habits which promote good health.
  • Contact your PCP for your non-emergency medical needs and understand when you should or should not go to the emergency room.
  • Pay all applicable service copayments at the time services are rendered and pay for services or supplies not covered by Community First.
  • Contact CMS and Community First if there are any changes in family status, address, phone number, employment status and other insurance coverage.
  • Respect the dignity of other members and Community First staff and providers.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

Get Directions »

Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

Get Directions »

Monday - Friday

8:30am - 5:00pm

Member Services

210-358-6070 Commercial
210-358-6060 Star Medicaid
210-358-6403 STAR Kids
1-855-607-7827 STAR Kids Toll-Free
210-358-6300 Chip/Chip Perinatal
210-358-6080 TDD Local
1-800-390-1175 TDD Toll-Free
210-358-6400 HIE
888-512-2347 HIE Toll-Free

Behavorial Health

210-358-6100 Commercial

Behavorial Health & Substance Abuse

1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

Nurse Hotline

210-227-2347
Toll-Free 1-800-434-2347

contact banner

Preguntas Frecuentes para miembros de STAR Kids

¿Qué es la atención médica administrada?

La atención médica administrada le brinda a usted servicios de Medicaid a través de un grupo selecto de doctores, hospitales y otros proveedores de salud que se conoce como "red de proveedores", por medio del plan de salud que haya escogido.

¿Qué es un consultorio médico de cabecera?

Un consultorio médico de cabecera presta servicios de atención básica. Allí se encuentra su proveedor de cuidados primarios, quien ayuda a reforzar las relaciones del paciente y su familia con eldoctor y otros proveedores de atención médica.

¿Qué es un proveedor de cuidados primarios (PCP)?

Al inscribirse en el programa STAR Kids, tiene que elegir a un proveedor de cuidados primarios. Elproveedor puede ser un doctor, enfermero o clínica a través del cual usted recibirá los cuidados médicos esenciales y será enviado a otros tipos de atención médica. Los proveedores de cuidados primariosbrindan un consultorio médico de cabecera a los miembros del programa. Con el tiempo llegarán a familiarizarse con usted y con su historial médico. Su proveedor de cuidados primarios puede ser:

  • Un doctor especializado en medicina general
  • Un doctor de medicina familiar
  • Un doctor de medicina interna
  • Un pediatra
  • Un ginecoobstetra
  • Un enfermero registrado de práctica avanzada (APRN)
  • Un auxiliar médico (PA)
  • Una clínica (Centro de Salud Aprobado a Nivel Federal o Clínica de Salud Rural)
  • Un especialista dispuesto a brindar un consultorio médico de cabecera a ciertos miembros connecesidades o enfermedades especiales.Si tiene Medicare, no necesitará escoger a un proveedor de cuidados primarios.

  • ¿Puedo cambiar de proveedor de cuidados primarios (PCP)?

    Sí. Llame a su plan de salud para cambiar de proveedor de cuidados primarios.

    ¿Qué es STAR Kids y cuándo empezará el programa?

    STAR Kids es un nuevo programa de atención médica administrada de Medicaid de Texas para los niños y adultos de hasta 20 años de edad con alguna discapacidad. A través de STAR Kids, usted podrárecibir apoyos y servicios médicos básicos y a largo plazo de la red de proveedores del plan de salud. Si califica, recibirá servicios y apoyos a largo plazo, entre otros, ayuda en el hogar con las actividades diarias y ayuda para participar en las actividades comunitarias. Si califica, también recibirá los servicios opcionales del Programa para Niños Médicamente Dependientes (MDCP) a través de la red de proveedores del plan de salud. si usted califica, el programa STAR Kids empezará a nivel estatal el 1 de noviembre de 2016.

    ¿Qué servicios ofrece el programa STAR Kids?

    Todos los participantes reciben:

    • Un plan de servicios. Esto ayudará a sus doctores y otros proveedores a saber el tipo decuidados que usted necesita. Un coordinador de servicios del plan de salud de STAR Kidstrabajará con usted y con su doctor para crear este plan. El coordinador de servicios también leayudará a encontrar doctores, programar citas y atender a otras necesidades que pueda tener.

    • Un proveedor de cuidados primarios. Este proveedor le prestará la mayor parte de suatención médica preventiva. Su proveedor de cuidado primario también puede remitirlo aespecialistas en caso de ser necesario.

    o Si recibe Medicare, no podrá elegir a su proveedor de cuidados primarios.

    • Servicios básicos de atención médica. Recibirá los mismos servicios de Medicaid que ahora; porejemplo, consultas con doctores, visitas al hospital, terapias, consultas con especialistas,equipos médicos, medicamentos con receta y suministros médicos.

    • Servicios y apoyos a largo plazo (LTSS). Recibirá servicios y apoyos a largo plazo en el hogar; porejemplo, servicios de atención personal, Community First Choice y servicios de un enfermeroparticular. Entre los servicios y apoyos a largo plazo destaca la ayuda en casa con las actividadesesenciales de la vida diaria y ayuda para participar en las actividades comunitarias.

    Si recibe servicios a través de un programa opcional para personas con discapacidad intelectual o del desarrollo (IDD) del Departamento de Servicios para Adultos Mayores y Personas Discapacitadas (DADS), el programa opcional de Servicios de Empoderamiento Juvenil (YES), o si vive en un centro de atención intermedia (ICF-IID), recibirá servicios y apoyos a largo plazo a través de su programa opcional o centro igual que los recibe ahora.

    Si recibe servicios opcionales a través del Programa para Niños Médicamente Dependientes, recibirá esos mismos servicios a través del plan de salud de STAR Kids que escoja.

    • Para obtener más información sobre Community First Choice, visite el sitio web de CFC de la HHSC. Esta página ofrece información general sobre este beneficio pero no es específico de STAR Kids.

    Coordinación de servicios

    Las enfermeras de Community First Health Plans y otros profesionales serán sus coordinadores de servicios. Sus servicios incluyen los siguiente:

    La identificación de las necesidades de salud física y mental y de servicios y apoyos a largo plazo

    La creación de planes de servicios para atender a las necesidades identificadas

    La búsqueda de doctores que aceptan Medicaid

    El acceso a otros servicios y proveedores

    Servicios de valor agregado

    Estos son los servicios de valor agregado que Community First Health Plans ofrece. Estos incluyen:

    • Tarjeta de descuento en recetas médicas para los miembros de familia
    • Ocho (8) horas de cuidado para su niño en casa
    • $100.00 para terapias especiales
    • Ayuda telefónica temporal
    • Estuche y funda de almohada para miembros con Asma
    • Reuniones y consejos para madres nuevas
    • Clases para dejar de fumar
    • Progama de obesidad para jóvenes
    • Reproductor de MP3 con foros de salud
    • Servicios de notario para servicios medicos
    • Ayúda par encontrar y mantener un trabajo

    ¿Cómo sabré si un plan de salud de STAR Kids tiene contratos con mi doctor y otros proveedores?

    Cuando reciba su paquete de inscripción en agosto, revise si sus proveedores actuales aparecen en los directorios de proveedores adjuntos. Si uno de sus doctores no aparece en la lista, podrá llamar al plan médico para ver si el doctor tiene contrato con ellos. También podrá hablar con su doctor para que se ponga en contacto con los planes de salud para ver si lo pueden contratar.

    ¿Qué pasa si mi doctor no está inscrito en los planes de salud de STAR Kids disponibles en mi área de servicio?

    Puede preparar una lista de todos los proveedores que atienden a su hijo y comunicarse con ellos para pedirles que se inscriban con Community First Health Plans. También puede compartir su lista de proveedores con Community First Health Plans y pedirles que contraten a sus proveedores si no lo han hecho ya. Puede hacer esto hoy mismo.

    Los planes de salud de STAR Kids deben intentar comunicarse con todos los proveedores de Medicaid que atienden a los niños que pasarán al programa de STAR Kids. Los proveedores no tienen que firmar un contrato con un plan de salud si no lo desean. Los planes de salud y los proveedores pueden tener acuerdos de caso único cuando un proveedor sólo quiere atenderle a usted pero no a otros participantes del programa STAR Kids.

    ¿Qué pasa si tengo un seguro médico privado?

    Si tiene un seguro médico privado, éste pagará primero, y el plan de salud pagará el resto de los servicios cubiertos por Medicaid.

    ¿Qué pasa si mi proveedor de cuidados primarios (PCP) está cubierto por mi seguro privado pero no es un proveedor de Medicaid?

    La ley exige que sea un proveedor registrado con Medicaid quien ordene, remita y recete cualquier servicio de Medicaid. Si su proveedor de cuidado primario va a ordenar, remitir o recetar servicios de Medicaid, deberá completar una solicitud simplificada para seguir ordenando, remitiendo o recetando servicios o medicamentos que Medicaid reembolsará después.

    La HHSC trabaja con proveedores privados de todo el estado para que se registren con Medicaid, pero es importante que usted también hable con sus proveedores. Explíqueles que es importante que se registren con Medicaid para que usted pueda seguir recibiendo sus cuidados. No se cobra ninguna cuota por completar el proceso simplificado para ordenar, remitir y recetar, y pueden registrarse por vía electrónica o llenando una solicitud impresa. Si su proveedor privado ordena, remite o receta servicios de Medicaid, debería visitar los siguientes enlaces:

    Después de haber escogido Community First, su coordinador de servicios de STAR Kids puede ayudar a coordinar entre los proveedores privados y de Medicaid.

    ¿Qué pasa si tengo Medicare?

    Si tiene Medicare y Medicaid, se considera que tiene "doble cobertura", y podrá seguir recibiendo la mayoría de los servicios médicos básicos a través de sus doctores de Medicare. STAR Kids no cambiará la manera en que usted recibe los servicios de Medicare.

    Medicare pagará la mayoría de sus servicios médicos básicos, y el programa tradicional de Medicaid pagará los servicios cubiertos por Medicaid pero no por Medicare. Si tiene Medicare, no escogerá un proveedor de cuidados primarios de STAR Kids.

    Después de haber escogido un plan de salud, su coordinador de servicios de STAR Kids le ayudará a coordinar entre sus proveedores de Medicare y Medicaid.

    Si mi proveedor de cuidados primarios (PCP) está cubierto por mi seguro privado, ¿debo escoger un proveedor de atención del programa STAR Kids?

    Si su proveedor de cuidados primarios no está registrado conCommunity First Health Plans de STAR Kids que ha escogido, tendrá que elegir a otro proveedor que sí lo esté. Esto significa que tendrá dos proveedores de cuidados primarios: un proveedor privado y otro registrado con el programa STAR Kids. Cuando haya escogido Community First y un proveedor de cuidados primarios de STAR Kids, su coordinador de servicios de Community First lo ayudará a coordinar entre sus proveedores privados, de Medicaid y de Medicare.

    Para más información acerca del programa de STAR Kids, visite la página web de la Comisión de Salud y Servicios Humanos de Texas.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Servicios de Valor Agregado de STAR Kids

    Community First Health Plans ofrece a sus miembros MÁS servicios de valor agregado que otros planes en el área de servicio. Como miembro de Community First, usted y su familia tienen acceso a:

    • Tarjeta de descuento en recetas médicas para los miembros de familia
    • Ocho (8) horas de cuidado para su niño en casa*
    • $100.00 para terapias especiales*
    • Ayuda telefónica temporal*
    • Estuche y funda de almohada para miembros con Asma
    • Reuniones y consejos para madres nuevas
    • Clases para dejar de fumar
    • Progama de obesidad para jóvenes
    • Reproductor de MP3 con foros de salud
    • Servicios de notario para servicios medicos
    • Ayúda par encontrar y mantener un trabajo*

    *Para miembros que califiquen

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Programa de STAR Kids

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    Community First: La primera opción para las familias que quieren lo mejor. 

    En Inglés

    Empezando 1 de Noviembre del 2016, Community Health Plans ofrecera un plan de salud para niños y jóvenes que reciben Medicaid por alguna discapacidad en la zona de servicio de Bexar. Este es el primer programa de atención médica administrada de Medicaid especialmente para las personas menores de 20 años que tienen una discapacidad y usan Medicaid.

    El programa de STAR Kids cubrirá a niños y jóvenes que reciven Medicaid relacionado con la Seguridad de Ingreso Suplementario, vivir en un centro para convalecientes o en un centro de atención intermedia para personas con una discapacidad intelectual o un padecimiento relacionado (ICF/IDD) en la comunidad, o un centro de enfermería, o estar escrito en un programa opcional de servicios en el hogar y en la comunidad, incluyendo:

    • Programa para Niños Medicamente Dependientes (MDCP)
    • Servicios en el Hogar y en la Comunidad (HCS)
    • Programa para Personas Sordociegas con Discapacidades Múltiples (DBMD)
    • Programa para Texas para Vivir en Casa (TxHml)
    • Servicios de Empoderamiento Juvenil (YES)

    Beneficios para Miembros

    STAR Kids está diseñado para cubrir las necesidades especiales de niños y jóvenes con discapacidades.

    Los miembros de este plan tendrán acceso a los siguientes beneficios:

    • Medicinas con receta
    • Servicios de cuidado personal
    • Equipo médico duradero y suministros
    • Cuidado de enfermería privado
    • Atención hospitalaria
    • Atención primaria y especializada
    • Trato preventivo
    • Servicios de MDCP

    Los niños que reciban Medicare seguirán usando Medicare para recibirlos servicios esenciales para la salud y las recetas médicas ordenadas por su doctor. Las familias recibirán asistencia para coordinar el trato de la salud. Community First Health Plans le ofrecerá servicios para la coordinación de la salud, el cual le ayudara a identificar necesidades de saludyconectar a los miembros con servicios y proveedores calificados. Los coordinadores de servicios de Community First decidirán las necesidades específicas de cada miembro para ayudar a la familia y al plan de salud en crear un servicio de salud personalizado. Los coordinadores de salud le proporcionaran un chequeo y un examen de rutina, examen y chequeo de STAR Kids (SK-SAI), para determinar las necesidades de cada niño así como ellos se relacionan con la salud y la vida independiente.

    Manual para Miembros


    Envíos a servicios, Autorizaciones, Continuidad de Cuidado


    Servicios de Valor Agregado


    Encuentre a su coordinador de servicio 


    Área de Servicio:

    El área de servicio de STAR Kids de Community First incluye los siguientes condados: Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina y Wilson.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Mosquito repellant

    Mosquito repellent is now available as a Medicaid benefit!

    Beginning August 9, 2016, Texas Medicaid will cover certain mosquito repellent products as a Medicaid benefit for the prevention of Zika virus. Zika can cause severe birth defects in unborn children whose mothers are infected while pregnant. Because there is not a vaccine to prevent the disease or medicine to treat it, it is important for women to use repellent to protect themselves and unborn babies.

    Who is covered?

    • Women ages 10-45 and Pregnant women of any age in the following programs:

    o Medicaid

    o Children's Health Insurance Program (CHIP)

    o CHIP-Perinate

    o Healthy Texas Women

    Benefit details:

    • A prescription is required, as with over-the-counter medications.
    • One can/bottle of mosquito repellent is permitted per prescription fill, with one refill allowed per calendar month.*
    • This benefit ends on October 31st, 2016.
    • Prescriptions for mosquito repellent will not count against the monthly 3 prescription limit for those clients with a monthly limit.
    • Repellent will be provided at no cost to Medicaid clients.
    • CHIP members may pay the generic copay or less, if the cost of the repellent is less than the copay.

    How to get repellent:

    • Contact your favorite pharmacy to make sure they are participating in this benefit. To find your pharmacy's phone number, you may use the Provider Lookup feature on our website: www.txvendordrug.com. If you are enrolled in an MCO, please refer to that MCO's website, or call the Member Services number on the back of your Member ID card.
    • Ask for a prescription for the mosquito repellent by contacting your healthcare provider, and then ask them to send it to your pharmacy
      o Your provider can send a prescription to your pharmacy via phone, fax, or e-prescription
      o Do not request an office visit only to request a prescription for mosquito repellent unless required by the healthcare provider
    • Have this prescription filled at your pharmacy.

    Where can I find more information about Zika and Zika prevention?

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR Kids Value Added Benefits

    Community First Health Plans offers its members the MOST value-added benefits than any other health plan in the service area. As a member of Community First, you and your family have access to:

    • A prescription discount card your whole family can use
    • Prenatal gift programs with up to $150 in gift cards*
    • Low-cost dental services for pregnant members*
    • Healthy Expectations Prenatal Program
    • Expectant mommy baby shower with free diaper bag and baby supplies
    • Birthing classes
    • New mommy mingle & advice meetings with free toddler booster seat1
    • Smoking cessation program
    • Asthma kit and Asthma pillow cover
    • Asthma gift programs with up to $20 in gift cards*
    • Help with getting a ride to medical appointments or health classes
    • Diabetes program with up to $50 in gift card incentives*
    • Weight management program
    • Digital media player with health podcast
    • Temporary phone help*
    • $10 gift card for follow-up appointment after leaving behavioral health hospital
    • Online mental health resources
    • Notary Services
    • Home visits for high-risk pregnant women
    • Texas Health Steps program with up to $270 in gift cards*
    • Personal counseling from nurse for asthma, diabetes, pregnancy and behavioral health issues
    • Eight hours of in-home respite care services*
    • $100 specialized therapies allowance
    • Pre-vocational assistance

    *Limitations or restrictions may apply. Please call Member Services for more information.

    1 Proof of completed well child checkup required.

    To find out how to obtain these value-added benefits, please call Member Services toll-free at 1-855-607-7827 (STAR Kids Hotline). You can also ask your assigned service coordinator for more information.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR Kids FAQs for Providers

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR Kids FAQs for Members

    What is managed care?

    Managed care means you get Medicaid services through a select group of doctors, hospitals, and other health care providers --called a provider network -- through a health plan you pick.

    What is a medical home?

    A medical home is where you get your basic care. It includes your primary care provider. It helps build the relationships between the patient and family with the doctor and other care providers.

    What is a Primary Care Provider (PCP)?

    When you join STAR Kids, you will pick a primary care provider. This is a doctor, nurse, or clinic where you will get basic medical care and get referrals for other care. Primary care providers are a medical home to members. They get to know you and your health history. Your primary care provider can be one of the following:

    • General practice doctor
    • Family practice doctor
    • Internal medicine doctor
    • Pediatric doctor
    • Obstetrics/Gynecology doctor
    • Advanced Practice Registered Nurse (APRN)
    • Physician Assistant (PA)
    • Clinic (Federally Qualified Health Center or Rural Health Clinic)
    • Specialist physicians willing to provide a health home to selected members with special needs or conditions

    If you have Medicare, you won't need to pick a primary care provider.

    Can I change my Primary Care Provider (PCP)?

    You may change your PCP by making a request through our secure member portal or by calling Member Services toll-free at 1-855-607-7827.

    What if I need to see a specialist or go to the hospital?

    Your primary care provider will help you with basic medical care. If you need other medical services, your primary care provider will give you a referral. For example, if you need to see a specialist or go to the hospital, your primary care provider will set that up for you.

    You don't need a referral from your primary care provider for some services, like:

    • Mental health and drug and alcohol abuse treatment
    • Texas Health Steps checkups
    • Emergency room services

    What is STAR Kids and when does it start?

    STAR Kids is a new Texas Medicaid managed care program for children and adults 20 or younger who have disabilities. Under STAR Kids, you get basic medical and long-term services and supports through Community First’s provider network. Long-term services and supports include things like help in your home with basic daily activities, and help participating in community activities, if you are eligible. You also will get Medically Dependent Children Program (MDCP) waiver services through Community First’s provider network, if you are eligible. STAR Kids will begin November 1, 2016.

    What services does STAR Kids offer?

    Everyone will get:

    • A care plan. This will help your doctors and other providers know what kind of care you need. A Community First service coordinator will work with you and your doctor to create this plan. The service coordinator will help you find doctors, make appointments, and help with other needs you may have.
    • A primary care provider. You will get most of your preventive healthcare through your primary care provider. Your primary care provider can also refer you to specialists, if needed. If you get Medicare, you will not choose a primary care provider.
    • Basic health care services. You will get Medicaid services like you get now, such as doctor’s visits, hospital visits, therapies, specialist visits, medical equipment, prescription drugs, and medical supplies.
    • Long-Term Services and Supports (LTSS). You will get long-term services and supports in the home, like Personal Care Services, Community First Choice, or Private Duty Nursing. Long-term services and supports include things that help you in your home with basic daily activities, and help you participate in community activities.

    If you get services through a Department of Aging and Disability Services (DADS) intellectual and developmental disability (IDD) waiver, the Youth Empowerment Services (YES) waiver, or live in an Intermediate Care Facility (ICF-IID), you will get your long-term services and supports through your waiver or facility, the way you do today.

    If you get services through Medically Dependent Children Program (MDCP) waiver, you will get those services through Community First Health Plans.

      • To learn more about the Community First Choice, visit the HHSC CFC webpage. The page gives general information about the benefit and isn't specific to STAR Kids.

    Service Coordination 

    Community First Health Plans nurses and other professionals will be your service coordinators. Their services include things like:

    • Identifying physical health, mental health, and long-term services and supports needs
    • Creating service plans to address identified needs
    • Finding doctors who will take Medicaid
    • Getting access to other services and providers

    Value-added services

    These are the extra services offered by Community First Health Plans. They include:

      • Prescription discount card for your family for prescription medicines and certain over the counter medicines.
      • Additional eight hours of in-home respite care services for non-waiver STAR Kids members.
      • Up to $100 specialized therapies allowance.
      • Pre-vocational assistance.
      • Free cell phone with free minutes.
      • Asthma kit and asthma pillow cover.
      • Mommy mingle and advice support meetings with free toddler booster seat.
      • Smoking cessation program.
      • Youth obesity weight management program.
      • Gift programs for health-related items for disease management.
      • MP3 player with health podcast.
      • Notary services for health related items.

    How will I know if my doctors and other providers are contracted with Community First Health Plans?

    When you get your enrollment packet in August, check the enclosed provider directories for the providers you see today. If one of your doctors isn't listed, call Community First at 1-855-607-7827 to see if they are contracted with them. You can also talk to your doctor about joining Community First Health Plans.

    What if my doctor isn't enrolled with Community First Health Plans?

    You can make a list of all the providers your child sees, and contact them to encourage them to enroll with Community First Health Plans. You can also share your provider list with Community First and ask them to contract with your providers if they haven't done so already. You can do this today.

    STAR Kids health plans must try to contract with all Medicaid providers who see children going into STAR Kids today. Providers don't have to contract with a health plan if they don't want to. Health plans and providers can do single-case agreements in some situations if a provider only wants to see you, but not everyone else in STAR Kids.

    What if I have private health insurance?

    If you have private health insurance, your private insurance will pay first, then Community First will pay the rest of any service covered by Medicaid.

    What if my primary care provider (PCP) is under my private insurance and isn't a Medicaid provider?

    The law requires that orders, referrals, and prescriptions for Medicaid services come from a Medicaid enrolled provider. If your private primary care provider will be ordering, referring, or prescribing Medicaid services, your doctor must complete a shortened application to continue ordering, referring, or prescribing services or medicines that will be reimbursed by Medicaid.

    HHSC is working with private providers around the state to try to get them to enroll in Medicaid, but it is important for you to talk to your providers, too. Tell them how important it is to enroll with Medicaid so they can continue your care. There are no fees to complete the shortened ordering, referring, and prescribing process, and they can sign up electronically or on paper. If your private provider is ordering, referring, or prescribing Medicaid services, they should visit the following links:

    Information for Ordering and Referring-Only providers

    Enroll Online:https://secure.tmhp.com/ProviderEnrollment

    Paper Application

    After you have joined Community First, your STAR Kids service coordinator can help coordinate between private providers and Medicaid providers.

    What if I have Medicare?

    If you have Medicare and Medicaid, you are known as a "dual eligible," and will keep getting most of your basic health-care services through your Medicare doctors. STAR Kids will not change the way you get Medicare services.

    Medicare will pay for most of your basic healthcare services, and traditional Medicaid will pay for services that are covered by Medicaid but aren't covered by Medicare. If you have Medicare, you won't pick a STAR Kids primary care provider.

    After you have picked Community First as your health plan, your Community First STAR Kids service coordinator will help coordinate between Medicare providers and Medicaid providers.

    If my primary care provider (PCP) is under my private insurance, do I have to choose a STAR Kids primary care provider?

    If you have private insurance you are not required to pick a Primary Care Provider (PCP) with Community First STAR Kids. If your primary insurance PCP is not in the Community First Network, you may continue to see your private insurance PCP provided they have enrolled with the Texas Medicaid program. The Affordable Care Act requires provider compliance with completing the shortened application to continue to order, refer or prescribe Medicaid covered services.

    Please note that it is important for you to talk to your providers. Tell them how important it is to enroll with Medicaid so they can continue your care. There is a short application your PCP or specialist needs to complete so that they can continue to order, refer and prescribe services for you covered by Medicaid. Enrolling to Texas Medicaid does not require your PCP to see all Medicaid members.

    For more information about the STAR Kids program, visit the Texas Health and Human Services Commission website.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Value-Added Benefits

    Community First Health Plans offers its members the MOST value-added benefits than any other health plan in the service area. As a member of Community First, you and your family have access to:

    • 24-Hour Nurse Advice Line to help you when you cannot reach your doctor
    • Extra vision benefits, up to $125 allowance for prescription glasses or $75 allowance for contact lenses
    • Prescription discount card for your family
    • Free sports physicals
    • Healthy Expectations prenatal program
    • Mommy and Me Baby Showers
    • Mommy Mingle classes with free toddler booster seat
    • Newborn and postpartum classes for new dads
    • Gift programs: Up to $20 in gift cards from your choice of retailer for STAR or CHIP Perinatal pregnant members
    • Smoking cessation program
    • Youth obesity weight management program
    • Asthma kit
    • Asthma pillow cover
    • Gift programs: Up to $50 in gift cards for STAR and CHIP members with asthma for enrolling in AsthmaMatters program and completion of certain asthma-related screenings
    • Help getting a ride to your medical appointments or health education classes
    • Gift programs: Up to $50 in gift cards for STAR and CHIP members with diabetes who enroll into diabetes management program
    • Gift programs: Up to $30 in gift cards for members who enroll in the Diabetes in Control program and complete certain diabetic screenings
    • Adult healthy lifestyle classes
    • MP3 player with health podcast
    • Low-cost dental referrals
    • Free cell phone with free minutes*
    • Free Zumba classes
    • Free Bike safety and repair classes
    • Notary services
    • Gift for completion of follow-up appointment after leaving hospital for behavioral health related admission
    • Online mental health resources

    *restrictions may apply

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Contact

    If you have any questions, call us. Community First Member Services staff can take your call from 8 a.m. to 5 p.m. You can reach a nurse 24 hours a day, 7 days a week. They can answer your health questions after hours, weekends, and holidays. Our staff is bilingual in English and Spanish. If you speak another language or are hearing impaired, call Member Services. 

    STAR Kids Members can speak to a Service Coordinator for help with benefits. We have dedicated Service Coordinators who can help you understand the STAR Kids program, covered services, and provider resources.

    For Emergency Services dial 9-1-1 or go to the nearest emergency room. 

    Member Services Hotline:

    STAR Kids: (210) 358-6403 or toll-free 1-855-607-7827

    STAR Medicaid: (210) 358-6060 or toll-free 1-800-434-2347

    CHIP/CHIP Perinatal: (210) 358-6300 or toll-free 1-800-434-2347

    HIE: (210) 358-6400 or toll-free 1-888-512-2347

    Commercial: (210) 358-6070 or toll-free 1-800-434-2347

    TDD: (210) 358-6080 or toll-free 1-800-390-1175

    Hours of Operation: Monday-Friday, 8 a.m. - 5 p.m. 

    Provider Hotline: 

    (210) 358-6030 or toll-free 1-800-434-2347

    Hours of Operation: Monday-Friday, 8:30 a.m. - 5 p.m.

    Talk to a provider relations representative about the health plan and member benefits.

    Behavioral Health & Substance Abuse Hotline:

    1-877-221-2226

    Call toll-free to talk to a representative about your benefits. You do not need a referral for mental health or substance abuse services.

    Nurse Advice Line:

    Community First Health Plans has a Nurse Advice Line available 24 hours a day, 7 days a week, 365 days a year – to help you get the care you need. Nurses can help you with medical advice, such as what to do for a common cold or how to care for a loved one released from the hospital.

    1-800-434-2347

    Medicaid Managed Care Program Help Line:

    STAR Program: 1-800-964-2777

    STAR Kids Program: 1-877-782-6440

    TTY Line for hearing impaired (STAR): 1-800-735-2889

    TTY Line for hearing impaired (STAR Kids): 1-800-267-5008

    Appeal or Fair Hearing:

    If you disagree with the health plan's decision to cover something, you can ask your health plan for a fair hearing. You must ask for a fair hearing within 90 days of the date on the health plan's letter with a decision.

    STAR Program: 1-800-434-2347

    STAR Kids Program: 1-855-607-7827

    Corporate Office:

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office:

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday-Friday

    8:30 a.m.- 5 p.m.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Exhibits

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Utilization Management Disclosure

    At Community First Health Plans, it is not a condition of employment or part of the evaluation process to base performance ratings, allow compensation or financial incentives for:

    • The number of adverse determinations
    • Limitations on lengths of stay, benefits, services, or charges
    • The number or frequency of telephone calls or other contacts with health care providers or patients
    • To encourage decisions that result in under-utilization

    Utilization Management decision-making is based only on appropriateness of care, service, and existence of coverage.

    Members who have questions or who are in need of assistance regarding the Utilization Management process may call Community First Health Plans at:

    LocalToll Free
    Medicaid Members:(210) 358-60601-800-434-2347
    CHIP Members:(210) 358-63001-800-434-2347
    Commercial Members:(210) 358-60701-800-434-2347
    ERS Members:(210) 358-62621-877-698-7032
    University Family Care Plan Members:(210) 358-60901-800-434-2347


    Providers with questions regarding the Utilization Management Process, or who wish to obtain a copy of the criteria used in the decision making process, may call the Health Services Management Resolution Unit at (210) 358-6050.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Medicaid Member Rights and Responsibilities

    Medicaid Member Rights and Responsibilities

    MEMBER RIGHTS:

    1.You have the right to respect, dignity, privacy, confidentiality and nondiscrimination. That includes the right to:

    a.Be treated fairly and with respect.

    b.Know that your medical records and discussions with your providers will be kept private and confidential.

    2.You have the right to a reasonable opportunity to choose a health care plan and primary care provider. This is the doctor or health care provider you will see most of the time and who will coordinate your care. You have the right to change to another plan or provider in a reasonably easy manner. That includes the right to:

    a.Be told how to choose and change your health plan and your primary care provider.

    b.Choose any health plan you want that is available in your area and choose your primary care provider from that plan.

    c.Change your primary care provider.

    d.Change your health plan without penalty.

    e.Be told how to change your health plan or your primary care provider.

    3.You have the right to ask questions and get answers about anything you do not understand. That includes the right to:

    a.Have your provider explain your health care needs to you and talk to you about the different ways your health care problems can be treated, regardless of cost or what your benefits cover.

    b.Be told why care or services were denied and not given.

    4.You have the right to agree to or refuse treatment and actively participate in treatment decisions. That includes the right to:

    a.Work as part of a team with your provider in deciding what health care is best for you.

    b.Say yes or no to the care recommended by your provider.

    5.You have the right to use each complaint and appeal process available through the managed care organization and through Medicaid, and get a timely response to complaints, appeals and fair hearings. That includes the right to:

    a.Make a complaint to your health plan or to the state Medicaid program about your health care, your provider or your health plan.

    b.Get a timely answer to your complaint.

    c.Use the plan’s appeal process and be told how to use it.

    d.Ask for a fair hearing from the state Medicaid program and get information about how that process works.

    6.You have the right to timely access to care that does not have any communication or physical access barriers. That includes the right to:

    a.Have telephone access to a medical professional 24 hours a day, 7 days a week to get any emergency or urgent care you need.

    b.Get medical care in a timely manner.

    c.Be able to get in and out of a health care provider’s office. This includes barrier free access for people with disabilities or other conditions that limit mobility, in accordance with the Americans with Disabilities Act.

    d.Have interpreters, if needed, during appointments with your providers and when talking to your health plan. Interpreters include people who can speak in your native language, help someone with a disability, or help you understand the information.

    e.Be given information you can understand about your health plan rules, including the health care services you can get and how to get them.

    f.Get information about health plan providers and your member rights and responsibilities.

    7.You have the right to not be restrained or secluded when it is for someone else’s convenience, or is meant to force you to do something you do not want to do, or is to punish you.

    8.You have a right to know that doctors, hospitals, and others who care for you can advise you about your health status, medical care, and treatment. Your health plan cannot prevent them from giving you this information, even if the care or treatment is not a covered service.

    9.You have a right to know that you are not responsible for paying for covered services. Doctors, hospitals and others cannot require you to pay copayments or any other amounts for covered services.

    10.You have a right to make recommendations about the health plan’s member rights and responsibilities policy.

    MEMBER RESPONSIBILITIES:

    1.You must learn and understand each right you have under the Medicaid program. That includes the responsibility to:

    a.Learn and understand your rights under the Medicaid program.

    b.Ask questions if you do not understand your rights.

    c.Learn what choices of health plans are available in your area.

    2.You must abide by the health plan's and Medicaid's policies and procedures. That includes the responsibility to:

    a.Learn and follow your health plan's rules and Medicaid rules.

    b.Choose your health plan and a primary care provider quickly.

    c.Make any changes in your health plan and primary care provider in the ways established by Medicaid and by the health plan.

    d.Keep your scheduled appointments.

    e.Cancel appointments in advance when you cannot keep them.

    f.Always contact your primary care provider first for your non-emergency medical needs.

    g.Be sure you have approval from your primary care provider before going to a specialist.

    h.Understand when you should and should not go to the emergency room.

    3.You must share information about your health with your primary care provider and learn about service and treatment options. That includes the responsibility to:

    a.Tell your primary care provider about your health.

    b.Talk to your providers about your health care needs and ask questions about the different ways your health care problems can be treated.

    c.Help your providers get your medical records.

    4.You must be involved in decisions relating to service and treatment options, make personal choices, and take action to keep yourself healthy. That includes the responsibility to:

    a.Work as a team with your provider in deciding what health care is best for you.

    b.Understand how the things you do can affect your health.

    c.Do the best you can to stay healthy.

    d.Treat providers and staff with respect.

    e.Talk to your provider about all of your medications.

    5. STAR Kids members are responsible for participating in the STAR Kids assessment process with their assigned service coordinator. 

    If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services (HHS) toll-free at 1-800-368-1019. You can also view information concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    CHIP Member Rights & Responsibilities

    CHIP Member Rights and Responsibilities

    Member Rights and Responsibilities

    FOR CHIP MEMBERS AND CHIP PERINATE NEWBORN MEMBERS

    MEMBER RIGHTS:

    1.You have a right to get information about Community First, its services, its providers, and member rights and responsibilities.

    2.You have the right to get accurate, easy-to-understand information to help you make good choices about your child’s health plan, doctors, hospitals and other providers.

    3.Your health plan must tell you if they use a “limited provider network.” This is a group of doctors and other providers who only refer patients to other doctors who are in the same group. "Limited provider network" means you cannot see all the doctors who are in your health plan. If your health plan uses “limited networks,” you should check to see that your child’s primary care provider and any specialist doctor you might like to see are part of the same “limited network.”

    4.You have a right to know how your doctors are paid. Some get a fixed payment no matter how often you visit. Others get paid based on the services they give to your child. You have a right to know about what those payments are and how they work.

    5.You have a right to know how the health plan decides whether a service is covered and/or medically necessary. You have the right to know about the people in the health plan who decide those things.

    6.You have a right to know the names of the hospitals and other providers in your health plan and their addresses.

    7.You have a right to pick from a list of health care providers that is large enough so that your child can get the right kind of care when your child needs it.

    8.If a doctor says your child has special health care needs or a disability, you may be able to use a specialist as your child’s primary care provider. Ask your health plan about this.

    9.Children who are diagnosed with special health care needs or a disability have the right to special care.

    10.If your child has special medical problems, and the doctor your child is seeing leaves your health plan, your child may be able to continue seeing that doctor for three months, and the health plan must continue paying for those services. Ask your plan about how this works.

    11.Your daughter has the right to see a participating obstetrician/gynecologist (OB/GYN) without a referral from her primary care provider and without first checking with your health plan. Ask your plan how this works. Some plans may make you pick an OB/GYN before seeing that doctor without a referral.

    12.Your child has the right to emergency services if you reasonably believe your child’s life is in danger, or that your child would be seriously hurt without getting treated right away. Coverage of emergencies is available without first checking with your health plan. You may have to pay a co-payment depending on your income. Copayments do not apply to CHIP Perinatal Members.

    13.You have the right and responsibility to take part in all the choices about your child’s health care.

    14.You have the right to speak for your child in all treatment choices.

    15.You have the right to get a second opinion from another doctor in your health plan about what kind of treatment your child needs.

    16.You have the right to be treated fairly by your health plan, doctors, hospitals and other providers.

    17.You have the right to talk to your child’s doctors and other providers in private, and to have your child’s medical records kept private. You have the right to look over and copy your child’s medical records and to ask for changes to those records.

    18.You have the right to a fair and quick process for solving problems with your health plan and the plan’s doctors, hospitals and others who provide services to your child. If your health plan says it will not pay for a covered service or benefit that your child’s doctor thinks is medically necessary, you have a right to have another group, outside the health plan, tell you if they think your doctor or the health plan was right.

    19.You have the right to know that doctors, hospitals, and others who care for your child can advise you about your child's health status, medical care, and treatment. Your health plan cannot prevent them from giving you this information, even if the care or treatment is not a covered service.

    20.You have a right to know that you are only responsible for paying allowable copayments for covered services. Doctors, hospitals, and others cannot require you to pay any other amounts for covered services.

    21.You have a right to make recommendations regarding Community First’s member rights and responsibilities policy.

    MEMBER RESPONSIBILITIES

    You and your health plan both have an interest in seeing your child’s health improve. You can help by assuming these responsibilities.

    1.You must try to follow healthy habits. Encourage your child to stay away from tobacco and to eat a healthy diet.

    2.You must become involved in the doctor’s decisions about your child’s treatments.

    3.You must work together with your health plan’s doctors and other providers to pick treatments for your child that you have all agreed upon.

    4.If you have a disagreement with your health plan, you must try first to resolve it using the health plan’s complaint process.

    5.You must learn about what your health plan does and does not cover. Read your Member Handbook to understand how the rules work.

    6.If you make an appointment for your child, you must try to get to the doctor’s office on time. If you cannot keep the appointment, be sure to call and cancel it.

    7.If your child has CHIP, you are responsible for paying your doctor and other providers co-payments that you owe them. If your child is getting CHIP Perinatal services, you will not have any co-payments for that child.

    8.You must report misuse of CHIP or CHIP Perinatal services by health care providers, other members, or health plans.

    9.You must talk to your provider about your medications that are prescribed.

    10.You have a responsibility to provide information to Community First or its providers (to the extent possible) that is needed to provide care.

    If you think you have been treated unfairly or discriminated against, call the U.S. Department of Health and Human Services toll-free at 1-800-368-1019. You can also view information concerning the HHS Office of Civil Rights online at www.hhs.gov/ocr.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR Kids for Providers

    body-image


    Beginning November 1, 2016, Community First Health Plans will provide health care for children and youth who receive disability-related Medicaid in the Bexar service delivery area. The program is the first Medicaid managed care program specifically for people who are 20 and younger, have a disability, and use Medicaid.

    Patient Requirements

    The STAR Kids Program will cover children and youth ages 20 and younger who receive Supplemental Security Income-related Medicaid, live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility, or are enrolled in a home and community based services waiver program including:

    • Medically Dependent Children Program (MDCP)
    • Home and Community-based services (HCS)
    • Community Living Assistance and Support Services (CLASS)
    • Deaf Blind with Multiple Disabilities (DBMD)
    • Texas Home Living (HxHmL)
    • Youth Empowerment Services (YES)

    Program Benefits and Services

    STAR Kids is designed to meet the unique needs of children and youth with disabilities. The program will include access to benefits such as:

    • Prescription drugs
    • Hospital care
    • Primary and specialty care
    • Preventive care
    • Personal care services
    • Private duty nursing
    • Durable medical equipment and supplies
    • MDCP services

    Children who receive Medicare will keep using Medicare for basic health services and prescriptions ordered by their doctor. Families will receive assistance with coordinating care. Community First Health Plans will provide service coordination, which will help identify needs and connect members to services and qualified providers. Community First’s service coordinators will assess each member’s specific needs to help the family and health plan create a unique individual service plan. Service coordinators will provide a standard screening and assessment, STAR Kids Screening and Assessment (SK-SAI), to determine each child’s needs as they relate to health and independent living.

    Provider Training

    To register for training sessions, please call (210) 358-6030 or email nmcfhp@cfhp.com.

    Provider Manual


    Provider Forms


    FAQs


    Forms


    Provider Relations Contacts

    Service Area

    Community First's STAR Kids service area includes the following counties: Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina, Wilson.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR Kids for Members

    body-image


    Beginning November 1, 2016, Community First Health Plans will provide health care for children and youth who receive disability-related Medicaid in the Bexar service delivery area. The program is the first Medicaid managed care program specifically for people who are 20 and younger, have a disability, and use Medicaid.

    The STAR Kids Program will cover children and youth ages 20 and younger who receive Supplemental Security Income-related Medicaid, live in a community-based intermediate care facility for individuals with an intellectual disability or related condition (ICF/IID) or nursing facility, or are enrolled in a home and community based services waiver program including:

    • Medically Dependent Children Program (MDCP)
    • Home and Community-based services (HCS)
    • Community Living Assistance and Support Services (CLASS)
    • Deaf Blind with Multiple Disabilities (DBMD)
    • Texas Home Living (HxHmL)
    • Youth Empowerment Services (YES)

    Program Benefits and Services

    STAR Kids is designed to meet the unique needs of children and youth with disabilities. The program will include access to benefits such as:

    • Prescription drugs
    • Hospital care
    • Primary and specialty care
    • Preventive care
    • Personal care services
    • Private duty nursing
    • Durable medical equipment and supplies
    • MDCP services

    Children who receive Medicare will keep using Medicare for basic health services and prescriptions ordered by their doctor. Families will receive assistance with coordinating care. Community First Health Plans will provide service coordination, which will help identify needs and connect members to services and qualified providers. Community First’s service coordinators will assess each member’s specific needs to help the family and health plan create a unique individual service plan. Service coordinators will provide a standard screening and assessment, STAR Kids Screening and Assessment (SK-SAI), to determine each child’s needs as they relate to health and independent living.

    Contact

    (210) 358-6403 or toll-free 1-855-607-7827
    Monday-Friday 8 a.m.-5 p.m.

    Member Handbook


    Find a Provider


    FAQs


    Service Coordinator Lookup (coming soon)


    Service Area

    Community First’s STAR Kids service area includes the following counties: Atascosa, Bexar, Comal, Guadalupe, Kendall, Medina and Wilson.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Filing a Complaint (STAR/Medicaid Members)

    If you get benefits through Medicaid's STAR program, call your medical plan first. If you don't get the help you need there, you should do one of the following:

    a. Call Medicaid Managed Care Helpline at 1-866-566-8989 (toll free). 
    b. Online: Online Submission Form (only works in Internet Explorer)
    c. Mail: Texas Health and Human Services Commission
                Office of the Ombudsman, MC H-700
                P.O. Box 13247
                Austin, TX 78711-3247

    d. Fax: 1-888-780-8099 (Toll Free) 

    Please see the FAQ page for more information. 

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Authorization Lists

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Provider Forms

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Forms

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Forms

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Forms

    Provider Forms 

    • CHIP/CHIP Perinatal 
    • Texas Health Steps 
    • STAR/Medicaid 
    • Commercial HMO

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Mail Order Prescriptions

    Rx and Go Program

    The University Health System (UHS) Pharmacy Rx and Go Program is a prescription filling service for UFCP members. The Rx and Go Program is a prescription benefit at UHS outpatient pharmacies. To use the program, the prescription must be prescribed by a UHS/UT MED/CMA prescriber and must meet certain criteria to be filled at the UHS pharmacy. Certain maintenance medications may qualify for mail order and may be received for free. Please visit the UHS site for more information about this program.

    NoviXus Mail Order Program

    Plan members who use maintenance drugs may fill their prescription through mail order. The use of mail order is recommended only for maintenance drugs, rather than drugs that will be needed for a short time (e.g. antibiotics for an acute illness). Maintenance drugs are typically used to treat chronic, long-term conditions. The mail order program is voluntary.

    Before submitting your prescription and mail order form to NoviXus, you'll need to register for the program. You may register with NoviXus by visiting their site or by calling (877) 935-5797. Please allow up to 3 weeks for processing and delivery of your first order.

    After you are registered, complete and mail the NoviXus Order Form (along with your prescription) to the address listed on the form. Please allow up to 3 weeks for processing and delivery of your first order.

    NoviXus Mail Order Form

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Pharmacy Benefits

    Your Plan Year 2018 health plan includes a three-tier prescription drug benefit, which is administered by Community First Health Plans and our Pharmacy Benefit Manager (PBM), Navitus Health Solutions, in accordance with the plan design specified by University Health System.

    Preferred Drug List


    Navitus Participating Pharmacies

    Find a participating pharmacy near you.

    Prescription Discount Card


    Mail Order Prescriptions

    Learn more about the prescription mail order program and how to register.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Member ID Card

    Do not lose your card. Keep it for pharmacy, doctor and hospital visits. If you need to request a replacement or additional ID card, you may do so through our secure member portal. 

    You may also call Member Services at (210) 358-6090 or toll-free at (800) 227-CFHP.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Complaint Process

    How to File a Complaint/Appeal

    If you have concerns about the services you have received from a Community First Health Plans’ provider, please discuss them with your primary care physician (PCP). If your concerns cannot be resolved by your PCP, or if you have complaints or concerns about any aspect of your health plan, feel free to call Community First’s Member Services Department at (210) 358-6090 or toll-free at (800) 227-CFHP, or submit a written statement using the Complaint Form (link to complaint form [ask Selena Chavez in MS Resolution Unit for copy of most recent form, both English/Spanish]). The complaint form may be submitted to Community First at:

    Attn: Member Services Resolution Unit
    12238 Silicon Drive, Suite 100
    San Antonio, TX 78249

    You may also file a complaint through this website by using our secure member portal (link to member portal). Your communications will be encrypted and completely secure to ensure your privacy. We will conduct a full investigation of your complaint, and our decision will be forwarded to you in writing within 30 calendar days from receipt of your written complaint. Please be assured that filing a complaint will in no way result in discrimination against you.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Member Services

    Summary of Benefits and Coverage


    Contact Us

    Find Community First Health Plans contact information. 

    Complaint Process

    Learn how to file a complaint.

    Member ID Card

    Learn how to request additional ID cards.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Pharmacy Benefits

    Your Plan Year 2017 health plan includes a three-tier prescription drug benefit, which is administered by Community First Health Plans and our Pharmacy Benefit Manager (PBM), Navitus Health Solutions.

    HMO Complete Preferred Drug List


    Navitus Participating Pharmacies

    Find a participating pharmacy near you.

    Prescription Discount Card


    Mail Order Prescriptions

    Learn more about the prescription mail order program and how to register.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Member ID Card

    Do not lose your card. Keep it for pharmacy, doctor and hospital visits. If you need to request a replacement or additional ID card, you may do so through our secure member portal. 

    You may also call Member Services at (210) 358-6070 or toll-free at (800) 227-CFHP.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    How to File a Complaint/Appeal

    If you have concerns about the services you have received from a Community First Health Plans’ provider, please discuss them with your primary care physician (PCP). If your concerns cannot be resolved by your PCP, or if you have complaints or concerns about any aspect of your health plan, feel free to call Community First’s Member Services Department at (210) 358-6070 or toll-free at (800) 227-CFHP, or submit a written statement using the Complaint Form.  The complaint form may be submitted to Community First at:

    Attn: Member Services Resolution Unit
    12238 Silicon Drive, Suite 100
    San Antonio, TX 78249

    You may also file a complaint through this website by using our secure member portal. Your communications will be encrypted and completely secure to ensure your privacy. We will conduct a full investigation of your complaint, and our decision will be forwarded to you in writing within 30 calendar days from receipt of your written complaint. Please be assured that filing a complaint will in no way result in discrimination against you. At any time, you may file a complaint with the Texas Department of Insurance (TDI) by writing or calling:

    Texas Department of Insurance (TDI)
    P.O. Box 149104
    Austin, Texas 78714-9104
    (800) 252-3439

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Member Services

    Summary of Benefits and Coverage


    Contact Us

    Find Community First Health Plans contact information.

    Complaint Process

    Learn how to file a complaint.

    Member ID Card

    Learn how to request additional ID cards.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Mail Order Prescriptions

    Plan members who use maintenance drugs may fill their prescription through mail order. The use of mail order is recommended only for maintenance drugs, rather than drugs that will be needed for a short time (e.g. antibiotics for an acute illness). Maintenance drugs are typically used to treat chronic, long-term conditions. The mail order program is voluntary.

    Before submitting your prescription and mail order form to NoviXus, you'll need to register for the program. You may register with NoviXus by visiting their site or by calling (877) 668-4987. Please allow up to 3 weeks for processing and delivery of your first order.

    After you are registered, complete and mail the NoviXus Order Form (along with your prescription) to the address listed on the form. Please allow up to 3 weeks for processing and delivery of your first order.

    NoviXus Mail Order Form

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Navitus Participating Pharmacies

    Navitus Customer Care (toll-free): (866) 333-2757 

    Find a participating pharmacy near you. 

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Pharmacy Benefits

    Your Plan Year 2017 health plan includes a three-tier prescription drug benefit, which is administered by Community First Health Plans and our Pharmacy Benefit Manager (PBM), Navitus Health Solutions.

    Formulary List


    Navitus Participating Pharmacies

    Find a participating pharmacy near you. 

    Prescription Discount Card

    Learn more about the prescription mail order program and how to register.

    Mail Order Prescriptions

    Learn more about the prescription mail order program and how to register.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Asthma

    If you have asthma, you are not alone. In the United States, asthma affects about 25 million people. Asthma is a chronic lung condition that causes inflammation and swelling of the airways, sensitivity to things that make swelling worse (dust, tobacco smoke, animal dander), and decreased airflow in the lungs. It can affect your activity level, productivity, rest, and attendance at work or school.There is no cure for asthma, but you can learn to manage it so you can maintain a normal activity level and minimize the need for emergency treatment. Our AsthmaMatters Program was developed to provide you with some of the tools you need to prevent chronic and troublesome symptoms and improve your well-being. Members who have asthma are encouraged to complete a health survey. Based on the results, you will be enrolled in the asthma program that is right for you.Educational information is mailed to all AsthmaMatters participants throughout the year. Other aspects of our program help our members who have had difficulty controlling their asthma. These may include a peak flow meter and video, as well as a recommendation to attend an asthma education program.

    Our goals are to help you:

    • Understand the causes or triggers of your asthma;
    • Have normal or near-normal lung function;
    • Participate in physical activity without having asthma symptoms;
    • Decrease the frequency and severity of flare-ups;
    • Promote restful sleep; and
    • Increase your quality of life.

    Five essentials for good asthma control:

    • Learn as much as you can about asthma;
    • Identify and avoid things that make your asthma worse;
    • Monitor asthma symptoms and peak flow values;
    • Take asthma medicines as prescribed by your doctor; and
    • Have an action plan to help you handle an asthma flare up.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Diabetes

    If you are among the 26 million Americans who have diabetes, learn all that you can about your disease. People who take an active role in learning about diabetes are the most successful in preventing or delaying diabetes complications.

    When you enroll in the Diabetes in Control Program, you will receive ongoing information on topics such as:

    • Controlling your blood sugar;
    • Tips for talking to your doctor;
    • Routine diabetes screening tests;
    • Your role in understanding diabetes and preventing complications;
    • Blood sugar testing and supplies; and
    • What to do when you are sick.

    As a member of Community First, you may be eligible to attend diabetes education classes. Topics include:

    • Take control of your diabetes;
    • Learn all you can about diabetes;
    • Get regular checkups;
    • Check blood sugars at home;
    • Exercise regularly;
    • Maintain your recommended weight (even a small weight loss helps control your diabetes);
    • Take care of your skin and feet;
    • Follow a meal plan; and
    • Take medication if necessary.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Healthy Expectations

    The first and most important step to having a healthy baby is beginning prenatal care early, as soon as you know that you are pregnant.Through our Healthy Expectations Program, health educators and nurses work with you and your doctor to provide information and answer questions about your pregnancy. A short questionnaire helps us develop an action plan that is right for you and track your progress. Free, informal classes are held throughout the Bexar County area.You will receive information about:

    • Doctor visits and tests;
    • Your baby's growth;
    • The upcoming delivery;
    • Tips for caring for yourself after delivery; and
    • Your newborn's needs.

    If you are experiencing problems during your pregnancy, you may enroll in the Healthy Expectations Program. Nurses are available by telephone to answer your questions and give you the added support you may need at this special time.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Case Management

    Our Case Management staff is available to assist members who have a chronic health condition which requires health care services from several different providers. Community First Case Managers work with you, your family members, your doctors, and other members of your health care team, to be sure you are getting the type and level of care you need. They are available to help you understand your condition, planned tests and procedures, treatment options, and answer health care benefit questions.Community First Case Managers are able to:

    • Determine your needs;
    • Coordinate care with your doctors and therapists;
    • Develop a plan of care that is updated as often as needed;
    • Assist in ordering special equipment and supplies;
    • Coordinate behavioral health services;
    • Initiate home health care;
    • Assist with access to community programs;
    • Evaluate additional needs; and
    • Track your progress over time or changes in your condition.

    The goal of the “Case Management Program” is to ensure members have access to the most efficient and effective health care services they need to promote the highest quality of life possible.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Behavorial Health

    At times, our personal problems may seem too big to handle on our own. These issues and feelings can affect us at school or work, leading to problems on the job or causing stress and illness. Our family life and personal relationships can also be affected. Our Behavioral Health staff is available to provide information and help you choose a professional counselor or doctor who can help you with any of the following topics:

    • Aggressive behavior
    • Family violence
    • Anxiety
    • Grief
    • Autism
    • Suicidal behavior
    • Depression
    • School problems
    • Physical and sexual abuse
    • Divorce or marital problems
    • Drug and alcohol abuse
    • Stress
    • Eating disorders
    • Hyperactivity disorders
    • Emotional abuse
    • Temper tantrums

    Community First Behavioral Health staff can help you determine the type of behavioral health assistance you may need. Outpatient counseling services available include individual, couple, family, and group counseling. For those with more intensive treatment, services available include:

    • Intensive outpatient
    • Partial hospitalization
    • Inpatient hospitalization
    • Residential treatment

    If you are experiencing a chronic mental health condition or require coordination of multiple services, our Behavioral Health staff can assist you with case management services.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Disease Management

    Behavioral Health

    Find information on mental health benefits.

    Case Management

    Learn how our Case Management staff is available to assist members who have a chronic health condition.

    Healthy Expectations

    Learn more about our program designed to help expecting moms and babies.

    Diabetes

    Discover the tools we have available to help members diagnosed with Diabetes.

    Asthma

    Read about free resources available to our members diagnosed with asthma.

    Flu Updates

    Visit the Centers for Disease Control and Prevention website for the latest updates on influenza, commonly known as the Flu.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Member ID Card

    Do not lose your card. Keep it for pharmacy, doctor and hospital visits. If you need to request a replacement or additional ID card, you may do so through our secure member portal. 

    You may also call Member Services at (210) 358-6400 or toll-free at (888) 512-CFHP.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Complaint Process

    How to File a Complaint/Appeal

    If you have concerns about the services you have received from a Community First Health Plans’ provider, please discuss them with your primary care physician (PCP). If your concerns cannot be resolved by your PCP, or if you have complaints or concerns about any aspect of your health plan, feel free to call Community First’s Member Services Department at (210) 358-6400 or toll-free at (888) 512-CFHP, or submit a written statement using the Complaint Form.  The complaint form may be submitted to Community First at:

    Attn: Member Services Resolution Unit
    12238 Silicon Drive, Suite 100
    San Antonio, TX 78249

    You may also file a complaint through this website by using our secure member portal (link to member portal). Your communications will be encrypted and completely secure to ensure your privacy. We will conduct a full investigation of your complaint, and our decision will be forwarded to you in writing within 30 calendar days from receipt of your written complaint. Please be assured that filing a complaint will in no way result in discrimination against you. At any time, you may file a complaint with the Texas Department of Insurance (TDI) by writing or calling:

    Texas Department of Insurance (TDI)
    P.O. Box 149104
    Austin, Texas 78714-9104

    (800) 252-3439

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Contact Us

    UFCP Member Services 

    (210) 358-6090 (Local)

    (800) 227-CFHP (Toll-Free)

    HMO Member Services 

    (210) 358-6070 (Local)

    (800) 227-CFHP (Toll-Free)

    Health Insurance Marketplace Member Services

    (210) 358-6400 (Local)

    (888) 512-CFHP (Toll-Free) 

    TTY

    (210) 358-6080

    (800) 390-1175

    For emergency care

    9-1-1

    Secure Email

    Member portal 

    Hours of Operation:

    Monday – Friday
    8:30 a.m. – 5 p.m.
    After hours, calls are transferred directly to our Nurse Advice line.

    Corporate Address:

    12238 Silicon Drive, Suite 100
    San Antonio, TX 78249

    Community Outreach Office:

    1410 Guadalupe Street, Suite 222
    San Antonio, TX 78207

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Member Services

    Summary of Benefits and Coverage


    Contact Us

    Find Community First Health Plans contact information. 

    Complaint Process

    Learn how to file a complaint.

    Member ID Card

    Learn how to request additional ID cards.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Consumer Cost Transparency Guide

    Community First Health Plans is providing this link to provide information to consumers to better understand potential costs of receiving care at Texas hospitals. Please note, with the exception of emergency care, CFHP only covers care with participating providers in the CFHP service area. Care received from a non-participating provider may subject the member to being balance billed. For more information about CFHP providers, please see our “Find a Provider” page. If you have further questions, please call our Member Services department at (210) 358-6400 or toll-free at 1-888-512-CFHP (2347).

    Price Point Texas Hospital Information

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Child Health Clinical Record Forms

    Use the links below to download Child Health Clinical Record Forms. These forms are intended for use as a documentation tool for all required checkup components and should never be given out as a client questionnaire. Instructions are also available. The forms are recommended for your use by Texas Health Steps; they are not required.

    The Portable Document Format (PDF) forms include form fill fields (for example; text fields, check boxes) so that you can complete them online using an Acrobat product such as Adobe Reader, Acrobat 3D, Acrobat Professional, or Acrobat Standard.

    If you do not have Acrobat Reader, it is available free for Mac & PC at Adobe's website. Simply select the correct version for your particular computer and follow the directions provided. For additional information, please visit https://www.dshs.texas.gov/thsteps/Child-Health-Clinical-Record-Forms/

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    New Child Health Clinical Record Forms

    Use links below to download Child Health Clinical Record Forms. These forms are intended for use as a documentation tool for all required checkup components and should never be given out as a client questionnaire. Instructions are also available. The forms are recommended for your use by Texas Health Steps; they are not required.

    The Portable Document Format (PDF) forms include form fill fields (for example; text fields, check boxes) so that you can complete them online using an Acrobat product such as Adobe Reader, Acrobat 3D, Acrobat Professional, or Acrobat Standard.

    If you do not have Acrobat Reader, it is available free for Mac & PC at Adobe's website. Simply select the correct version for your particular computer and follow the directions provided.

    Instructions for Child Health Clinical Record Forms [PDF 83KB]

    Forms

    about us images

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Clinical Practice Guidelines

    The following documents are available in Adobe PDF format.

    Adobe Acrobat Reader is required to view the PDF documents. If you do not have Acrobat Reader, it is available free for Mac & PC at Adobe's website. Simply select the correct version for your particular computer and follow the directions provided. PDF files retain all document formatting, insuring the copy you get when you print the file will be the same as the one you would get from our office.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner
    contact banner

    Provider Educational Resources

    The following documents are provided in Adobe PDF format.
    Click to Get Acrobat Reader Free! If you do not have Acrobat Reader, it is available free for Mac & PC at Adobe's website.

    Simply select the correct version for your particular computer and follow the directions provided. PDF files retain all document formatting, insuring the copy you get when you print the file will be the same as the one you would get from our office.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    1% Reimbursement Reduction

    1% Reimbursement Reduction
    Professional Providers and Inpatient and Outpatient Facilities

    Effective for dates of service on or after September 1, 2010, Community First Health Plans will apply the HHSC mandated one percent reduction to the final payment amounts for inpatient, professional, and outpatient services for Medicaid and CHIP. Your individual participation in Community First Health Plans (CFHP) is greatly appreciated and has been key to our ability to maintain a viable full service quality network. Thank you for your continued support and cooperation.

    For more information please visit the TMHP Web site.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    CFHP Clinical Guidelines

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    2017 Physician Incentive Program

    The following documents are available in Adobe PDF format.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Pharmacy Reminder

    Fluticasone Reminder: It is that time of year again for nasal issues. Fluticasone is indicated for the management of the nasal symptoms of allergy season.

    • CHIP copays are based on the number of people in the family and the family’s income and assets. Copays range from $0 to $35 depending on the drug and CHIP member income level: 
    Chip Cost-SharingGeneric DrugBrand Drug
    At or below 100% of FPL$0$3
    Above 100% up to and including 150% of FPL$0$5
    Above 150% up to and including 185% of FPL$10$35
    Above 185% up to and including 200% of FPL$10$35
    • The program allows coverage for up to a 34-day supply.
    • The Managed Care Plans may allow up to a 90-day supply of certain maintenance medications.
    • The Managed Care pharmacy program allows an unlimited number of prescriptions to be dispensed each month.
    • Covered drugs may be obtained at retail or through mail order pharmacies.
    • Specialty pharmacy medications, as defined by the Texas Health and Human Services Commission, must be obtained from specialty pharmacy providers.
    • There is no cost sharing for CHIP Perinates.

    Pharmacy Reminder

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Texas Standardized Prior Authorization Request Form

    Texas Standardized Prior Authorization Request Form

    Beginning September 1, 2015, the Texas Standardized Prior Authorization Form for Health Care Services (Standard Prior Authorization Form) will be available for providers and health care facilities. Please review the announcement from the Texas Department of Insurance (TDI). 

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Texas Medicaid Vendor Drug Program Update

    Texas Medicaid Vendor Drug Program Update: Makena®

    The Texas Medicaid/CHIP Vendor Drug Program has added Makena® (17-alpha-hydroxyprogesterone or 17P) to the Texas Medicaid/CHIP formulary. Makena® is a non-compounded form of 17P, which unlike the compounded form of 17P, contains a preservative. Compounded 17P and Makena® have the same active pharmaceutical ingredient (API). Both medications are indicated to reduce the risk of preterm birth in women with a singleton pregnancy that have a history of singleton spontaneous live preterm birth. Although compounded preservative-free preparations of 17P have been available through local compounding pharmacies since 2003, many are phasing out this product since the commercially prepared 17P (Makena®) is now widely available. Prescriptions for Makena® can be filled at local retail pharmacies and require a prior authorization.

    The prior authorization form can be found at: https://www.navitus.com/texas-medicaid-star-chip/prior-authorization-forms.aspx

    For more information, please visit: http://www.txvendordrug.com/

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Medicaid Provider Re-Enrollment Requirement

    Due to a new federal mandate, all Texas Medicaid providers enrolled before January 1, 2013, must re-enroll in Texas Medicaid by March 24, 2016. This requirement applies to those providing services through a Medicaid managed care organizations (MCOs), dental maintenance organizations (DMOs), or through traditional fee-for-service Medicaid.

    Providers must be re-enrolled in Texas Medicaid to maintain credentialing with their contracting MCOs and DMOs. In order for a provider to maintain credentialing with their contracting MCOs or DMOs, the provider must be fully re-enrolled prior to the March 24, 2016, deadline. To be considered fully re-enrolled, providers must submit a completed re-enrollment application and receive notification from the Texas Medicaid & Healthcare Partnership (TMHP) that their application has been approved. To allow sufficient time for re-enrollment application processing, providers are encouraged to begin this process immediately.

    Failure to re-enroll may result in termination from the Medicaid program. Terminated providers are not eligible to receive payment for services rendered to fee-for-service recipients, or those enrolled with a Medicaid managed care organization (MCO) or dental maintenance organization (DMO).

    For more information visit:

    To get help:

    • Call the TMHP Contact Center at 1-800-925-9126, option 2 or the TMHP CSHCN Services Program Contact Center (1-800-568-2413)
    • Attend a workshop

    Additional Information:

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Provider Information

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Commercial Balance Billing Disclaimer

    Although health care services may be or have been provided to you at a health care facility that is a member of the provider network used by your health benefit plan, other professional services may be or have been provided at or through the facility by physicians and other health care practitioners who are not members of that network. You may responsible for payment of all or part of the fees for those professional services that are not paid or covered by your health benefit plan (TIC § 1456.006).

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR/Medicaid

    body-image


    En Inglés

    Qué es esto?

    Niños en Texas sin seguro de salud podrían calificar para obtener cobertura de salud a bajo costo o gratuita por medio del programa de seguro médico STAR Medicaid para niños. Este programa cubre las visitas al consultorio, medicamentos recetados, cuidado dental, exámenes de la vista, anteojos, y mucho más.

    ¿Qué es lo que cubre?

    • Visitas al dentista, limpiezas y empastes
    • Exámenes de la vista y anteojos
    • Elección de médicos, chequeos regulares y visitas al consultorio
    • Acceso a médicos especialistas y atención de salud mental
    • Atención y servicios de Hospital
    • Suministros médicos, radiografías y pruebas de laboratorio
    • Tratamiento de necesidades especiales de salud
    • Tratamiento de enfermedades preexistentes

    Familias con niños que reciben Medicaid para niños no pagan nada. Para obtener más información y para solicitar cobertura médica, visite www.chipmedicaid.org. También puede llamar al 1-877-543-7669.

    ¿Cuál es el área de servicio de Community First ?

    El área de servicio de Community First cubre los condados de Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina y Wilson.


    Pasos Sanos de Tejas

    Es para niños desde nacimiento hasta los 20 años de edad que tienen Medicaid. Pasos Sanos de Texas ofrece exámenes médicos y dentales con regularidad incluso servicios de administración de casos sin costo alguno para usted.

    Pasos Sanos de Texas puede:

    • ayudarle a encontrar un médico, dentista, o administrador de casos
    • ayudarle a hacer una cita para un chequeo
    • ayudarle a conseguir transportación o dinero para gasolina

    Llame a Community First Health Salud Preventiva al:

    210-358-6349 o al número gratuito 1-800-434-2347, opción 5

    Lunes - Viernes, 8:30 am - 5 pm, hora del centro o Llame a Texas Health Steps al número gratuito:

    1-877-847-8377 (1-877-THSTEPS)
    TTY: 1- 800 - RELAY TX (735-2989)
    Lunes - Viernes 8 am - 8 pm, hora del centro

    *Asegúrese de llevar a sus hijos a todos sus chequeos. De esta manera recibirán la atención que necesitan en las edades adecuadas.

    Cómo conseguir transportación al médico, dentista o farmacia

    Community First le proporcionará a usted pases para el autobús en caso de que no pueda llegar a su cita con el médico. Llame al departamento de Servicios para Miembros si necesita ayuda con el pago de autobús al:

    210-358-6349 o al número gratuito 1-800-434-2347, opción 5
    Lunes - Viernes, 8:30 am - 5 pm, hora del centro

    Si necesita transportación para ir al médico o al dentista, hospital, farmacia o cualquier lugar para recibir los servicios de Medicaid, llame al Programa de Transportación Médica al:

    210-949-2020 o al número gratuito 1-877-633-8747
    (1-877-MED-TRIP)
    TTY: 1-800-735-2989 Lunes - Viernes 8 am - 5 pm Hora del Centro

    Manual para miembros de STAR


    Cómo Presentar Una Queja

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    CHIP/CHIP Perinatal

    body-image


    En Inglés

    CHIP es un plan de atención administrada para los niños sin seguro médico en Texas. Nuestro objetivo es asegurar que los miembros de CHIP tengan acceso a los servicios de atención primaria adecuada y reciban servicios en el lugar más efectivo. Nuestra red está formada por médicos, profesionales de la salud aliados y auxiliares, hospitales y otros centros seleccionados para proporcionar atención médica de calidad a nuestros miembros de CHIP. El proveedor de cuidado primario (PCP) es responsable de el manejo del cuidado médico general de los pacientes, y de la coordinación de referencias a especialistas e instalaciones para pacientes hospitalizados / ambulantorios. El PCP es un proveedor de CHIP de la web de Community First con una de las siguientes especialidades: Medicina General, Medicina Familiar, Pediatría y Medicina Interna.

    Área de Servicio

    El área de servicio de Community First para el programa CHIP cubre los condados de Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina y Wilson.

    Programa CHIP Perinatal

    El programa del Seguro Médico para Niños (CHIP Perinatal) Programa Perinatal ofrece servicios a los niños no nacidos de mujeres que no son elegibles para Medicaid. Los niños no nacidos serán elegibles desde el nacimiento y, una vez inscritos, recibirán 12 meses de elegibilidad continua. Nuestro objetivo es asegurar que los miembros de CHIP Perinatal tengan acceso a servicios de atención primaria adecuada y y reciban servicios en el lugar más efectivo. Nuestra red está formada por médicos, profesionales de la salud aliados y auxiliares, hospitales y otros centros seleccionados para proporcionar atención médica de calidad a nuestros miembros de CHIP Perinatal. El proveedor de cuidado primario (PCP) es responsable de el manejo del cuidado médico general de los pacientes, y de la coordinación de referencias a especialistas e instalaciones para pacientes hospitalizados / ambulantorios. El PCP es un proveedor de CHIP de la web de Community First con una de las siguientes especialidades: Medicina General, Medicina Familiar, Pediatría y Medicina Interna

    Formas


    Manual de Proveedores

    Los siguientes documentos están disponibles en formato PDF de Adobe.Si usted no tiene Acrobat Reader, está disponible gratis para Mac y PC en el sitio web de Adobe. Sólo tiene que seleccionar la versión correcta para su equipo en particular y siga las instrucciones proporcionadas. Archivos PDF conservan todo el formato del documento, asegurando la copia que se obtiene al imprimir el archivo será el mismo que el que se obtiene de nuestra oficina.

    FAQs

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    CHIP/CHIP Perinatal

    body-image


    En Inglés

    Community First: La primera opción para las familias que quieren lo mejor.


    Niños en Texas sin seguro de salud podrían calificar para obtener cobertura de salud a bajo costo o gratis por medio del programa de seguro médico de Medicaid para niños (CHIP). Este programa cubre las visitas al consultorio, medicamentos recetados, cuidado dental, exámenes de la vista, anteojos, y mucho más. 

    ¿Qué es lo que cubre?

    • Visitas al dentista, limpiezas y empastes
    • Exámenes de la vista y anteojos
    • Elección de médicos, chequeos regulares y visitas al consultorio
    • Acceso a médicos especialistas y atención de salud mental
    • Atención y servicios de Hospital
    • Suministros médicos, radiografías y pruebas de laboratorio
    • Tratamiento de necesidades especiales de salud
    • Tratamiento de enfermedades preexistentes

    Familias con niños que reciben CHIP no pagan más de $50 al año por la cobertura de cuidado de salud. Algunas familias con CHIP también podrían pagar copagos por algunos servicios.

    Programa Perinatal de CHIP - Cobertura CHIP para los Niños no Nacidos

    Si está embarazada, es residente de Texas, no tiene seguro médico, y usted no puede obtener Medicaid, usted puede obtener la cobertura perinatal de CHIP. Esta cobertura es para su bebé por nacer. Cubre el parto, la salud de su bebé y los servicios médicos para sus primeros meses de vida.

    Los beneficios perinatales de CHIP incluyen:

    • Hasta 20 visitas prenatales
    • Cobertura de medicamentos recetados
    • El costo de dar a luz *
    • Dos visitas al médico para la mamá después del nacimiento del bebé
    • Los chequeos regulares, vacunas y recetas para su bebé

    * Hospitales y otros costos relacionados con el nacimiento del bebé. Los costos de parto que no resultan en nacimiento y parto falso no están cubiertos.

    Para obtener más información y para solicitar cobertura médica, visite www.yourtexasbenefits.com. También puede llamar al 1-877-543-7669.

    ¿Cuál es el área de servicio de Community First ?

    El área de servicio de Community First cubre los condados de Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina y Wilson.

    Manual para miembros de CHIP


    Cómo Presentar Una Queja

    Para obtener más información, visite nuestra página de preguntas frecuentes.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    STAR Medicaid

    En Inglés

    Community First Health Plans STAR '(Acceso de Reforma del Estado de Texas) es una opción de cuidado administrada por el Programa STAR para clientes de Medicaid. Los objetivos del Programa STAR son mejorar el acceso del cuidado de miembros para aumentar la calidad y la continuidad de cuidado de miembros, para disminuir el uso indebido del sistema de atención de salud, tales como visitas a la sala de emergencia para no-emergencias, para lograr costos -efectividad y eficiencia para el Estado y para la promoción de proveedor y satisfacción de los miembros. Community First Health Plans es capaz de asegurar que estos objetivos se logran debido a su diversa red, totalmente acreditada de médicos, profesionales de la salud aliados, proveedores auxiliares y hospitales.

    La red de Community First Health Plans está compuesta por médicos (médicos de cuidado primario y especialistas), aliados y proveedores de cuidado de la salud auxiliares, hospitales y otras instalaciones seleccionadas para proporcionar atención médica de calidad a nuestros miembros de STAR. El proveedor de cuidado primario (PCP) es responsable de el manejo del cuidado médico general de los pacientes, y de la coordinación de referencias a especialistas e instalaciones para pacientes hospitalizados / ambulantorios. Un PCP es un proveedor de STAR de la web de Community First Health Plans con una de las siguientes especialidades: Medicina General, Medicina Familiar, Medicina Interna, Obstetricia y Ginecología (sólo mujeres embarazadas), Pediatría, Centros de Salud Federales Calificados (FQHC por sus siglas en Ingles) o Centros de Salud Rurales (RHC). Además, los miembros del programa STAR de Community First Health Plans pueden tener acceso a enfermeras de práctica avanzada por contrato, asistentes médicos, y enfermeras parteras certificadas que practican bajo la supervisión de un médico por los servicios cubiertos correspondientes.

    Programa Pasos Sanos de Texas

    La evaluación periódica temprana, diagnóstico y tratamiento de Medicaid de Texas (EPSDT) es un programa de mandato federal de atención médica de prevención, diagnóstico y tratamiento para los beneficiarios de Medicaid que son de las edades de nacimiento hasta los 20 años de edad. En Texas, el programa EPSDT es conocido como Pasos Sanos de Texas. Pasos Sanos de Texas es administrado por el Departamento de Servicios de Salud de Texas (DSHS).

    A través de promociones, el personal de Pasos Sanos de Texas, o contratistas aconsejan a los miembros de STAR a utilizar los servicios de chequeo médico preventivo de Pasos Sanos de Texas cuando por primera vez son elegibles para Medicaid / Pasos Sanos de Texas y cuando es periódicamente el debido tiempo de su chequeo médico anual en el mes de su cumpleaños.

    A petición del miembro, el Programa de Transportación Médica (MTP por sus siglas en ingles) ayuda al miembro con la programación de transporte. Consulte la sección de MTP en la página 23 de este Manual de proveedor para obtener información más detallada.

    Los proveedores médicos de Pasos Sanos de Texas deben realizar chequeos médicos a cualquier miembro que esté actualmente inscrito en Medicaid y que son de las edades desde nacimiento hasta los 20 años de edad. Los proveedores también se les aconseja notificar al miembro cuando esté próximo a su chequeo médico de acuerdo con el horario programado de Pasos Sanos Texas.

    Nota: Miembros nuevos inscritos en el programa STAR, deben recibir un chequeo médico de Pasos Sanos de Texas dentro de los primeros 60 días a partir de la fecha de inscripción.

    La información contenida en este manual de Community First Health Plans es un resumen que complementa la versión de HHSC aprobado el Manual de Procedimientos de Proveedor de Medicaid de Texas 2009, y en concreto Pasos Sanos de Texas Sección # 43, y boletines bimensual de Texas Medicaid. Los proveedores son para referirse a estos documentos para obtener información detallada sobre el programa.

    Área de Servicio

    El área de servicio de Community First STAR cubre los condados de Atascosa, Bandera, Bexar, Comal, Guadalupe, Kendall, Medina y Wilson. 

    Formas


    Manual del Proveedor

    Los siguientes documentos están disponibles en formato PDF de Adobe. Haga clic para obtener el Acrobat Reader gratuito! Si usted no tiene Acrobat Reader, está disponible gratis para Mac y PC en el sitio web de Adobe. Sólo tiene que seleccionar la versión correcta para su equipo en particular y siga las instrucciones proporcionadas. Archivos PDF conservan todo el formato del documento, asegurando la copia que se obtiene al imprimir el archivo será el mismo que el que se obtiene de nuestra oficina.

    FAQs


    Formas Historia Clínica de Salud Infantil


    Calculadora de Texas examen de Pasos Sanos Debido

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    News

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Employers

    We understand the importance of well-planned health care for your business. No matter your company's size, we can work with you to find a health care solution to fit your needs. Utilize our online resources and services to easily navigate information pertinent to your business.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Members

    Welcome, Members!

    At Community First Health Plans, our goal is to help you -- whether that be learning how to use your plan benefits, or simply locating one of our network doctors in your neighborhood. We believe that sharing information is a way to ensure members receive the best care possible. This commitment to providing great health care benefits for our members is backed by outstanding service and delivered by people who live right here in South Texas.

    Below, please view our full list of resources available to you for a better health care experience.

    If you need help understanding this information or need in an alternate format such as larger print, another language, Braille, or in audio, please call us at 1-800-434-2347 and ask a Member Service Representative.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Providers

    Welcome, Providers!

    Thank you for choosing to partner with Community First Health Plans. Below you will find helpful materials and resources meant specifically for providers and office staff. We look forward to continued collaboration with our provider partners to deliver quality care, improve outcomes, and increase satisfaction for members.

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347

    contact banner

    Summary of Benefits and Coverage (SBCs)

    Our goal at Community First Health Plans is to help guide you to the best health care possible. In order to do this, we provide members with useful information to compare the different features of health benefits and coverage plans. Reference the information pages below to choose the best plan to suit your needs. 

    SBC Uniform Glossary

    Corporate Office

    12238 Silicon Drive, Suite 100

    San Antonio, TX 78249

    Get Directions »

    Community Office

    1410 Guadalupe Street Ste. 222

    San Antonio, TX 78207

    Get Directions »

    Monday - Friday

    8:30am - 5:00pm

    Member Services

    210-358-6070 Commercial
    210-358-6060 Star Medicaid
    210-358-6403 STAR Kids
    1-855-607-7827 STAR Kids Toll-Free
    210-358-6300 Chip/Chip Perinatal
    210-358-6080 TDD Local
    1-800-390-1175 TDD Toll-Free
    210-358-6400 HIE
    888-512-2347 HIE Toll-Free

    Behavorial Health

    210-358-6100 Commercial

    Behavorial Health & Substance Abuse

    1-877-221-2226 Crisis Hotline 24/7 CHIP and Medicaid

    Nurse Hotline

    210-227-2347
    Toll-Free 1-800-434-2347