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COMMUNITY CARES

Providing superior care to our Members together.

child in pink jacket playing the doctor with teddy bear

Community Cares

Connecting you to the best health insurance for every stage of life.

 

COVID-19 Updates

Resources and information about COVID-19 for Community Providers.

 

Provider Newsletter

Get the latest on Community in our 2024 Vol 3 Provider newsletter.

 

Texas Health Steps Training

Keep up-to-date with annual mandatory Texas Health Steps.

 

Provider Notices

Read all about important notices.

 
COVID-19 Updates
Resources and information about COVID-19 for Community Providers.
 
Provider Newsletter

Get the latest on Community in our 2024 Vol 2 Provider newsletter.

 
Annual Mandatory Texas Health Steps Training
Keep up-to-date with Texas Health Steps.
 
Provider Notices
Read all about important notices.

Marketplace Plans

Community proudly offers individual health insurance in the new Health Insurance Marketplace.

With a range of plan options to fit any budget, and a network of doctors you can trust, like Memorial Hermann, Community makes it easy to get the care you need and deserve.

Medicare D-SNP

Community’s (HMO D-SNP) plan offers additional benefits and services not covered under Original Medicare, such as dental, hearing aids, and vision. You keep all your Medicaid benefits. You get all of Original Medicare’s covered services.

You may be eligible if you have Medicare Parts A and B, qualify for Texas Medicaid QMB or QMB+ and live in our service area.


Texas CHIP Plan

Community participates in the Children’s Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P).

  • CHIP is a health insurance plan for children under the age of 19. It is designed for families who earn too much money to qualify for Texas Medicaid programs but cannot afford to buy private insurance. CHIP-P provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid.

Texas STAR (Medicaid) Plan

Community participates in the State of Texas Access Reform (STAR) Managed Care Program (Medicaid).

As a part of Medicaid, Community provides both Children’s Medicaid and Medicaid for pregnant women. These programs are at no cost to U.S. residents who cannot afford health insurance.

Texas STAR+PLUS Plan

Members can request a copy at no charge to you upon request. For assistance scheduling an appointment Call Member Services 1.888.495.2850
Texas CHIP Plan

Community participates in the Children’s Health Insurance Program (CHIP), including CHIP Perinatal (CHIP-P).

CHIP is a health insurance plan for children under the age of 19 and is designed for families who earn too much money to qualify for Texas Medicaid programs yet cannot afford to buy private insurance. CHIP-P provides prenatal care for the unborn children of low-income women who do not qualify for Medicaid.

Texas STAR (Medicaid) Plan

Community participates in the State of Texas Access Reform (STAR) Managed Care Program (Medicaid).

As a part of Medicaid, Community provides both Children’s Medicaid and Medicaid for pregnant women. These programs are at no cost to U.S. residents who cannot afford health insurance.

Marketplace

Community proudly offers individual health insurance in the new Health Insurance Marketplace.

With a range of plan options to fit any budget, and a network of doctors you can trust like Memorial Hermann, Community makes it easy to get the care you need and deserve.

Medicare D-SNP

Community’s (HMO D-SNP) plan offers additional benefits and services not covered under Original Medicare, such as dental, hearing aids, and vision. You keep all your Medicaid benefits. You get all of Original Medicare’s covered services.

You may be eligible if you have Medicare Parts A and B, qualify for Texas Medicaid QMB or QMB+ and live in our service area.

Texas Medicaid & Healthcare Partnership (TMHP) Notice

In addition to updating information with Community Health Choice, Providers must:

Update your enrollment and demographic information with TMHP (Texas Medicaid Healthcare Partnership). TMHP is HHSC’s provider enrollment administrator and serves as the authoritative source for HHSC Providers’ enrollment and demographic information. Once you update your enrollment and demographic information with TMHP, your data will be reconciled with the demographic information on file with the MCOs.

To make updates to your current enrollment (e.g., new practice locations or change of ownership updates), please access the web page titled “Provider Enrollment on the Portal – A Step-by-Step Guide” at the following URL: https://www.tmhp.com/sites/default/files/microsites/enrollment/index.html.

For instructions on how to make other demographic updates to your current enrollment, please access the document titled “Provider Information Management System (PIMS) User Guide” at the following URL: https://www.tmhp.com/sites/default/files/file-library/edi/PIMS-user-guide-r2020-11- 19.pdf.

Otherwise, you can contact TMHP directly at 800-925-9126 for assistance.

Provider Services

Hours: Monday – Friday, 8:00 a.m. – 5:00 p.m.
Local: 713.295.2295
Toll-free: 1.888.760.2600
Email: ProviderWebInquiries@CommunityHealthChoice.org

Provider Relations

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 always there to answer my questions and help me and my family with our medical needs. I truly appreciate and value their customer support and service.”

– Cecily
Member of Community Health Choice

Provider Alert Update!

Effective immediately, Community is changing the paper claims address for all lines of business.

Learn More!

CYBER SECURITY ENHANCEMENTS: Multi-Factor Authentication implementation in August 2024

Dear Valued Provider Portal User,

In response to increasing cybersecurity threats, we are enhancing the security of your login credentials for accessing the Community Health Choice provider portal. Starting August 2024, we will be implementing Multi-Factor Authentication (MFA), also known as two-step verification.

  • Set up your mobile cell phone for SMS text delivery code to your mobile device.

Contact Provider Services if you are not able to use any of the above options

Learn More!

Effective on August 1, 2024

Community Health Choice will begin implementing additional enhancements to our claims editing programs that promote correct coding and billing practices for all lines of business (STAR, CHIP, Medicare/DSNPand Marketplace)

After the implementation, you may receive claims denials or payment changes based on these enhanced claim editing concepts on your Explanation of Benefits or electronic remittances. 

Learn More!