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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:

Local Toll Free
STAR Medicaid Members: (210) 358-6060 1-800-434-2347
STAR Kids Members (210) 358-6403 1-855-607-7827
CHIP/CHIP Perinatal Members: (210) 358-6300 1-800-434-2347
Commercial Members: (210) 358-6070 1-800-434-2347
ERS Members: (210) 358-6262 1-877-698-7032
University Family Care Plan Members: (210) 358-6090 1-800-434-2347

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 Population Health Management Resolution Unit at (210) 358-6050.

Corporate Office

12238 Silicon Drive, Suite 100

San Antonio, TX 78249

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Community Office

1410 Guadalupe Street Ste. 222

San Antonio, TX 78207

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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

Toll-Free 1-800-434-2347