Community First Health Plans at a glance
| Legal name | Community First Health Plans, Inc. |
|---|---|
| Also known as | CFHP, University Health System Community First |
| Category | Medicaid MCO |
| Parent organization | University Health System (Bexar County, TX) |
| Claims payer ID | COMMF — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility (270/271) payer ID | COMMF — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | COMMF — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Texas |
| Members covered | ~160k members |
| Provider resource entry point | https://communityfirsthealthplans.com/ProviderPortal |
| Provider phone | 1-210-358-6030 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Community First Health Plans
The 2026 quick reference lists 95-day filing for commercial/UFCP, CHIP, STAR/STAR Kids/STAR+PLUS and Marketplace/UCCP, and 120 days for Medicare Advantage/D-SNP. Confirm the start event and exceptions in the applicable manual. Appeals and COB have separate product-specific rows.
| Submission type | Window |
|---|---|
| Initial claim reference | 95 days for listed plans; Medicare Advantage 120 |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Community First Health Plans. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Community First Health Plans provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Community First Health Plans
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Community First Health Plans electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Community First Health Plans. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Community First Health Plans
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Community First Health Plans volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | COMMF — registry reference; verify the member product, transaction and clearinghouse |
| 270 / 271 eligibility | Listed in registry; verify current scope | COMMF — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | COMMF — registry reference; verify the member product, transaction and clearinghouse |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
provider_phone, payer_ids.claims, portal_url, timely_filing_days
Source comparison: 2026-09-18
The guide confirms provider services 210-358-6030 and Availity claims ID COMMF. Filing is 95 days for listed commercial/CHIP/STAR/Marketplace programs but 120 days for Medicare Advantage/D-SNP. Its separate appeals table is not a universal ladder.
Primary source for provider_phone, payer_ids.claims, portal_url, timely_filing_days
Not checked in this pass: All fields outside the specifically scoped findings, including legal-entity/NAIC identifiers, current enrollment and geographic coverage; Product-complete initial, corrected, secondary and appeal rules; applicable contracts and exceptions; Transaction-specific payer IDs, ERA enrollment and X12 278 unless explicitly established above; Prior-authorization code samples and current clinical criteria; QuickIntell capability/outcome claims and historical DataForSEO demand values; Accountable whole-record editorial approval (not supplied).
State coverage
Community First Health Plans operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Community First Health Plans
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Community First Health Plans; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Community First Health Plans; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Community First Health Plans before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Community First Health Plans
Where is the Community First Health Plans provider portal?
Use https://communityfirsthealthplans.com/ProviderPortal as a starting point for Community First Health Plans provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Community First Health Plans?
The 2026 quick reference lists 95-day filing for commercial/UFCP, CHIP, STAR/STAR Kids/STAR+PLUS and Marketplace/UCCP, and 120 days for Medicare Advantage/D-SNP. Confirm the start event and exceptions in the applicable manual. Appeals and COB have separate product-specific rows.
What is the Community First Health Plans payer ID?
Claims: COMMF — registry reference; verify the member product, transaction and clearinghouse. Eligibility (270/271): COMMF — registry reference; verify the member product, transaction and clearinghouse. ERA (835): COMMF — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Community First Health Plans accept electronic claims?
Verify Community First Health Plans electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Community First Health Plans denial?
This registry has not established a payer-specific appeal ladder for Community First Health Plans. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Community First Health Plans prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Community First Health Plans provider phone number?
This registry lists 1-210-358-6030 as a contact reference for Community First Health Plans. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
Automate workflows around Community First Health Plans requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Community First Health Plans's current published documents before submission. CPT® is a registered trademark of the American Medical Association.