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  • Community First Appeal Form

Get Community First Appeal Form

Nd a copy of the EOP, along with the any information related to appeal to: Community First Health Plan Attn: Claims Resolution Department 12238 Silicon Drive, Suite 100 San Antonio, Texas 78249 Keeping our commitment to you NM 4.00057 Rev. 1 3/11 (210) 227-2347 Toll-Free 1-800-343-2347 Fax (210) 358-6014 12238 Silicon Drive, Suite 100 San Antonio, Texas 78249 www.cfhp.com.

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A written appeal request with all required documentation must be received by Medical and Utilization Review (UR) Appeals within 120 calendar days of the date of the decisions letter. HHSC Medical and UR Appeals may ask for additional documentation.

Requesting a Redetermination The appellant (the individual filing the appeal) has 120 days from the date of receipt of the initial claim determination to file a redetermination request.

An appeal may be requested in person, by phone, fax or mail. You also may appeal if the agency fails to take action on a request for services.

TIMELY FILING APPEALS The standard timely filing period for Aetna Better Health of Texas is 95 days, measured from the claim date of service or the paid date of the primary carrier's EOP, whichever is later. Corrected claims must be received within 120 days of the first denial of the service.

You have 60 days from the date on the Notice of Action to file an appeal with Molina Healthcare.

How do I file an appeal? If you have received a Notice of Agency Action, instructions for requesting an appeal are included on the notice. If you have not received a notice, contact 2-1-1 or visit your local office. An appeal may be requested in person, by phone, fax or mail.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232