Frequently Asked Questions

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Frequently Asked Questions

Health Insurance Marketplace

Provider FAQs

The Claims mailing address is:
Community Health Choice
P.O. Box 301424 
Houston, TX 77230

Or you can file electronically: Electronic Payor ID number for Community is 60495.
Clearninghouse: Change Health Care

Or send via certified mail to:
Community Health Choice
2636 South Loop West, Suite 125
Houston, TX 77054

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

Call Community Health Choice Provider Services at 713.295.6704 to ask specific questions about payment and claims issues. Most times they can research and provide answers immediately. If you have further questions or feel you are still in disagreement, you may file a request for reconsideration of a claim within 180 days of receiving the initial EOP.

The mailing address for Claims Payment Reconsiderations is:

Community Health Choice
ATTN: Claims Payment Reconsiderations
2636 South Loop West, Suite 125
Houston, TX 77054

You may also fax requests for reconsiderations to 713.295.7027.

We do not require a referral for you to refer a Member to an in-network specialist. You can confirm a network specialist by checking this website or by calling our Provider Services at 713.295.6704.

Web FAQs

You can do the following:

  • Click on “Register Today” here or in top right-hand corner of the screen.
  • Complete the Secure Access Application and click submit.
  • Application will be reviewed and upon approval account will be created.

Once your application is received, we will establish your secure access login name and personal identification number (PIN) within three working days.

You can search by using any of these options:

  • Case/Claim Number
  • Member Number
  • Member Name

You can:

  • Integrate and automate Member eligibility
  • Submit delivery and pregnancy notifications
  • Send and view authorizations from one page

You can search by using any of these options:

  • Member number
  • Date of service
  • Claim number

You can search by using either of these options:

  • Check Date
  • Invoice Number

CHIP/STAR (Medicaid)

Provider FAQs

The Claims mailing address is:
Community Health Choice 
P.O. Box 301404
Houston, TX 77230-1404

Or you can file electronically:
Electronic Payor ID number for Community is 48145

Clearinghouses include:
Availity
Change Healthcare Trizetto

TMHP

Or send via certified mail to:
Community Health Choice
2636 South Loop West, Suite 125
Houston, TX 77054

We follow NHIC guidelines. Refer to the Texas Medicaid Provider Manual for specific filing instructions. You will find it the TMHP website at http://www.tmhp.com/Pages/Medicaid/
Medicaid_Publications_Provider_manual.aspx.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 120 days from the disposition of a claim to submit a request for reconsideration of a claim or appeal a decision related to medical necessity.

We follow NHIC guidelines. Refer to the Texas Medicaid Provider Manual for specific filing instructions. You will find it in the TMHP website at http://www.tmhp.com/Pages/Medicaid/
Medicaid_Publications_Provider_manual.aspx
.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 120 days from the disposition of a claim to submit a request for reconsideration of a claim or appeal a decision related to medical necessity.

Call Community Health Choice Provider Services at 713.295-.2295 to ask specific questions about payment and claims issues. Most times they can research and provide answers immediately. If you have further questions or feel you are still in disagreement, you may file a request for reconsideration of a claim within 120 days of receiving the initial EOP.

The mailing address for Claims Payment Reconsiderations is:

Community Health Choice
ATTN: Claims Payment Reconsiderations
2636 South Loop West, Suite 125
Houston, TX 77054

You may also fax requests for reconsiderations to 713.295.2291.

At no time can a Provider bill a Community Health Choice Member for a covered service provided. The Medicaid STAR Program does not require any co-payments from STAR Members.

Please visit the Join Community page for more information.

We do not require a referral for you to refer a Member to an in-network specialist. You can confirm a network specialist by checking this website or by calling our Provider Services at 713-295-2295.

Please call Provider Services to see if we are in the process of contracting with the hospital. In addition, Medical Affairs may be able to authorize out-of-network hospitals if an in-network hospital is not located nearby and if you are unable to manage the Member’s care at an in-network facility. Medical Affairs and Provider Services will work with you and hospitals to ensure optimum treatment for our Members.

Community most frequently pays 100% of then current Medicaid Allowable for Medicaid covered benefit codes. Variance may occur according to contract.

According to Medicaid rules and Community guidelines, Members may access THSteps services from any willing THSteps Provider. We request out-of-network Providers call to confirm Member eligibility and to confirm information for claims payment. Community will pay 100% of then current Medicaid Allowable to any THSteps Provider who fulfills THSteps services to a Member within the correct eligibility guidelines.

Community offers value-added benefits for Members including care management programs, access to health education, vision and dental benefits, a 24-hour Nurse Advice Line, and more. Please call Community for more information.

A Provider may file a complaint with Community at any time.

Submit complaints to:
Community Health Choice
Attn: Service Improvement
2636 South Loop West, Suite 125
Houston, TX 77054
Fax: 713.295.7036
Email: [email protected]

Community shall acknowledge all oral and written complaints within five business days. Community shall acknowledge, investigate and resolve all complaints no later than the 30th calendar day after the date Community receives the oral or written complaint.

After a Provider has exhausted the appeal process with Community, a Provider has the right to file a complaint with HHSC.

Send Provider appeals to HHSC to:
Texas Health and Human Services Commission
Re: Provider Complaint Health Plan Operations, H-320
P.O. Box 85200
Austin, TX 78708
Email: [email protected]

Web FAQs

You can do the following:

  • Click on the Provider tab on the left side of the page.
  • Click on “Register Here.”
  • Complete the Secure Access Application.
  • Send it to Community Health Choice.

Once your application is received, we will establish your secure access login name and personal identification number (PIN) within three working days.

You can search by using any of these options:

  • Case/Claim Number
  • Member Number
  • Member Name

You can:

  • Integrate and automate Member eligibility
  • Submit delivery and pregnancy notifications
  • Send and view authorizations from one page

You can search by using any of these options:

  • Member Number
  • Date of Service
  • Claim Number

You can search by using either of these options:

  • Check Date
  • Invoice Number

Health Insurance Marketplace

Provider FAQs

The Claims mailing address is:
Community Health Choice
P.O. Box 301424
Houston, TX 77230

Or you can file electronically: Electronic Payor ID number for Community is 60495.

Clearninghouse:
Change Health Care

Or send via certified mail to:
Community Health Choice
2636 South Loop West, Suite 125
Houston, TX 77054

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

Call Community Health Choice Provider Services at 713.295.6704 to ask specific questions about payment and claims issues. Most times they can research and provide answers immediately. If you have further questions or feel you are still in disagreement, you may file a request for reconsideration of a claim within 180 days of receiving the initial EOP.

The mailing address for Claims Payment Reconsiderations is:

Community Health Choice
ATTN: Claims Payment Reconsiderations
2636 S. Loop West, Suite 125
Houston, TX 77054

You may also fax requests for reconsiderations to 713.295.7027.

We do not require a referral for you to refer a Member to an in-network specialist. You can confirm a network specialist by checking this website or by calling our Provider Services at 713-295-6704.

The Claims mailing address is:
Community Health Choice
P.O. Box 301424
Houston, TX 77230

Or you can file electronically: Electronic Payor ID number for Community is 60495.

Clearninghouse:
Change Health Care

Or send via certified mail to:
Community Health Choice
2636 South Loop West, Suite 125
Houston, TX 77054

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

Call Community Health Choice Provider Services at 713.295.6704 to ask specific questions about payment and claims issues. Most times they can research and provide answers immediately. If you have further questions or feel you are still in disagreement, you may file a request for reconsideration of a claim within 180 days of receiving the initial EOP.

The mailing address for Claims Payment Reconsiderations is:

Community Health Choice
ATTN: Claims Payment Reconsiderations
2636 S. Loop West, Suite 125
Houston, TX 77054

You may also fax requests for reconsiderations to 713.295.7027

We do not require a referral for you to refer a Member to an in-network specialist. You can confirm a network specialist by checking this website or by calling our Provider Services at 713.295.6704.

Web FAQs

You can do the following:

  • Click on “Register Today” here or in top right-hand corner of the screen.
  • Complete the Secure Access Application and click submit.
  • Application will be reviewed and upon approval account will be created.

Once your application is received, we will establish your secure access login name and personal identification number (PIN) within three working days.

You can search by using any of these options:

  • Case/Claim Number
  • Member Number
  • Member Name

You can:

  • integrate and automate Member eligibility
  • submit delivery and pregnancy notifications
  • send and view authorizations from one page

You can search by using any of these options:

  • Member number
  • Date of service
  • Claim number

You can search by using either of these options:

  • Check Date
  • Invoice Number

The Claims mailing address is:
Community Health Choice
P.O. Box 301424
Houston, TX 77230

Or you can file electronically: Electronic Payor ID number for Community is 60495.

Clearninghouse:
Change Health Care

Or send via certified mail to:
Community Health Choice
2636 South Loop West, Suite 125
Houston, TX 77054

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 180 days from the disposition of a claim to submit a request for reconsideration of a claim or to appeal a decision related to medical necessity.

Call Community Health Choice Provider Services at 713-295-6704 to ask specific questions about payment and claims issues. Most times they can research and provide answers immediately. If you have further questions or feel you are still in disagreement, you may file a request for reconsideration of a claim within 180 days of receiving the initial EOP.

The mailing address for Claims Payment Reconsiderations is:

Community Health Choice
ATTN: Claims Payment Reconsiderations
2636 South Loop West, Suite 125
Houston, TX 77054

You may also fax requests for reconsiderations to 713.295.7027

We do not require a referral for you to refer a Member to an in-network specialist. You can confirm a network specialist by checking this website or by calling our Provider Services at 713-295-6704.

Web FAQs

You can do the following:

  • Click on “Register Today” here or in top right-hand corner of the screen.
  • Complete the Secure Access Application and click submit.
  • Application will be reviewed and upon approval account will be created.

Once your application is received, we will establish your secure access login name and personal identification number (PIN) within three working days.

You can search by using any of these options:

  • Case/Claim Number
  • Member Number
  • Member Name

You can:

  • integrate and automate Member eligibility
  • submit delivery and pregnancy notifications
  • send and view authorizations from one page

You can search by using any of these options:

  • Member number
  • Date of service
  • Claim number

You can search by using either of these options:

  • Check Date
  • Invoice Number

CHIP/STAR (Medicaid)

Provider FAQs

The Claims mailing address is:
Community Health Choice
P.O. Box 301404
Houston, TX 77230-1404

Or you can file electronically:
Electronic Payor ID number for Community is 48145

Clearinghouses include:
Availity
Change Healthcare Trizetto

TMHP

Or send via certified mail to:
Community Health Choice
2636 South Loop West, Suite 125
Houston, TX 77054

We follow NHIC guidelines. Refer to the Texas Medicaid Provider Manual for specific filing instructions. You will find it the TMHP website at http://www.tmhp.com/Pages/Medicaid/Medicaid_Publications_Provider_manual.aspx.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 120 days from the disposition of a claim to submit a request for reconsideration of a claim or appeal a decision related to medical necessity.

We follow NHIC guidelines. Refer to the Texas Medicaid Provider Manual for specific filing instructions. You will find it in the TMHP website at http://www.tmhp.com/Pages/Medicaid/Medicaid_Publications_Provider_manual.aspx.

The deadline for filing Clean Claims is 95 days from the date of service.

The Provider has 120 days from the disposition of a claim to submit a request for reconsideration of a claim or appeal a decision related to medical necessity.

Call Community Health Choice Provider Services at 713.295.2295 to ask specific questions about payment and claims issues. Most times they can research and provide answers immediately. If you have further questions or feel you are still in disagreement, you may file a request for reconsideration of a claim within 120 days of receiving the initial EOP.

The mailing address for Claims Payment Reconsiderations is:

Community Health Choice
ATTN: Claims Payment Reconsiderations
2636 South Loop West, Suite 125
Houston, TX 77054

You may also fax requests for reconsiderations to 713.295.2291.

At no time can a Provider bill a Community Health Choice Member for a covered service provided. The Medicaid STAR Program does not require any co-payments from STAR Members.

Please visit the Join Community page for more information.

We do not require a referral for you to refer a Member to an in-network specialist. You can confirm a network specialist by checking this website or by calling our Provider Services at 713.295.2295

Please call Provider Services to see if we are in the process of contracting with the hospital. In addition, Medical Affairs may be able to authorize out-of-network hospitals if an in-network hospital is not located nearby and if you are unable to manage the Member’s care at an in-network facility. Medical Affairs and Provider Services will work with you and hospitals to ensure optimum treatment for our Members.

Community most frequently pays 100% of then current Medicaid Allowable for Medicaid covered benefit codes. Variance may occur according to contract.

According to Medicaid rules and Community guidelines, Members may access THSteps services from any willing THSteps Provider. We request out-of-network Providers call to confirm Member eligibility and to confirm information for claims payment. Community will pay 100% of then current Medicaid Allowable to any THSteps Provider who fulfills THSteps services to a Member within the correct eligibility guidelines.

Community offers value-added benefits for Members including care management programs, access to health education, vision and dental benefits, a 24-hour Nurse Advice Line, and more. Please call Community for more information.

A Provider may file a complaint with Community at any time.

Submit complaints to:
Community Health Choice
Attn: Service Improvement
2636 South Loop West, Suite 125
Houston, TX 77054
Fax: 713.295.7036
Email: [email protected]

Community shall acknowledge all oral and written complaints within five business days. Community shall acknowledge, investigate and resolve all complaints no later than the 30th calendar day after the date Community receives the oral or written complaint.

After a Provider has exhausted the appeal process with Community, a Provider has the right to file a complaint with HHSC.

Send Provider appeals to HHSC to:
Texas Health and Human Services Commission
Re: Provider Complaint Health Plan Operations, H-320
P.O. Box 85200
Austin, TX 78708
Email: [email protected]

Web FAQs

You can do the following:

  • Click on the Provider tab on the left side of the page.
  • Click on “Register Here.”
  • Complete the Secure Access Application.
  • Send it to Community Health Choice.

Once your application is received, we will establish your secure access login name and personal identification number (PIN) within three working days.

You can search by using any of these options:

  • Case/Claim Number
  • Member Number
  • Member Name

You can:

  • Integrate and automate Member eligibility
  • Submit delivery and pregnancy notifications
  • Send and view authorizations from one page

You can search by using any of these options:

  • Member Number
  • Date of Service
  • Claim Number

You can search by using either of these options:

  • Check Date
  • Invoice Number

Why Choose Community?

As a local nonprofit health plan, Community Health Choice gives you plenty of reasons to join our Community. From the benefits and special programs we offer, to the way our Member Services team helps you make the most of them, Community is always working life forward for you and your family.

Community Health Choice is one of the greatest companies that I know. This program gives me hope in our Community.