Member Rights and Forms

Member Rights and Forms.

Quality Assurance Policy

The quality of our care and services is very important to Community, as is our Members’ safety. Our Quality Improvement Program uses things like quality scores, reports, and Member and Provider satisfaction surveys to see how we are doing.

Quality Assurance Policy

Member Rights and Responsibilities

Our Responsibilities as Your Health Plan:
Give you information about the plan, its network of providers, and your covered services. We must provide information in a way that works for you (in languages other than English, Braille, large print or other alternative formats).

Member Rights and Responsibilities

Determination/Redetermination

An appeal is a formal way of asking us to review and change a coverage decision we have made.

Prior Authorization

For prior authorizations for certain services, your Provider must contact us by telephone, electronically or in writing to request appropriate authorization.

Direct Member Reimbursement (DMR) Form

Use these forms when you pay full price for a something you believe should have been covered by your plan. Complete the Part C Form for medical (doctor’s office) expenses and the Part D Form for pharmacy expenses.

Mail to:
Claims Payment Request
O. Box 301404
Houston, TX 77230-1404