Use our online Provider Search to find a Primary Care Provider or clinic. It is updated every weekday, excluding holidays. You also can search through our printed directories, which are updated quarterly.
A referral is a consultation for evaluation and/or treatment of a patient requested by one doctor to another doctor. Community Health Choice will not pay the cost of non-emergency hospital care or medical equipment unless your Primary Care Provider gives you a referral.
Acute care — Preventive care, primary care, and other medical care provided under the direction of a provider for a condition having a relatively short duration.
Agency option (AO) — A service delivery option under which the provider is responsible for managing the day-to-day activities of the attendant and all business details.
Appeal
A request for your managed care organization to review a denial or a grievance again.
Community First Choice (CFC) option — Personal assistance services; habilitation services focused on the acquisition, maintenance and enhancement of skills; emergency response services; and support management provided in a community setting for eligible Medicaid Members in the STAR+PLUS Home and Community Based Services program who have received an institutional Level of Care (LOC) determination.
Community Living Assistance and Support Services (CLASS) — A non-capitated 1915(c) waiver which provides home and community–based services to individuals with intellectual or developmental disabilities.
Complaint
A grievance that you communicate to your health insurer or plan.
Copayment
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Consumer Directed Services Employer – A member or legally authorized representative (LAR), parent, or court appointed guardian who chooses to participate in the CDS option and therefore is responsible for hiring and retaining service providers to deliver program services.
Consumer Directed Services (CDS) option — A service delivery option in which a member or LAR employs and retains service providers and directs the delivery of eligible STAR+PLUS Home and Community Based Services (HCBS) program services. A member participating in the CDS option is required to use a financial management services agency (FMSA) chosen by the member or LAR to provide financial management services.
Durable Medical Equipment (DME)
Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches, or blood testing strips for diabetics.
Emergency Medical Condition
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
Emergency Medical Transportation
Ground or air ambulance services for an emergency medical condition.
Emergency Room Care
Emergency services you get in an emergency room.
Emergency Services
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Excluded Services
Health care services that your health insurance or plan doesn’t pay for or cover.
Grievance
A complaint to your health insurer or plan.
Habilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
Health Insurance
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
Home and community-based services (HCS) — A non-capitated 1915(c) waiver which provides home and community-based services to individuals with intellectual or developmental disabilities as cost-effective alternatives to institutional care.
Home Health Care
Health care services a person receives in a home.
Hospice Services
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
Hospitalization
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
Hospital Outpatient Care
Care in a hospital that usually doesn’t require an overnight stay.
Individual service plan (ISP) — An individualized and person-centered plan in which a member enrolled in the STAR+PLUS HCBS program operated by the MCO, with assistance as needed, identifies and documents his or her preferences, strengths, and health and wellness needs in order to develop short-term objectives and action steps to ensure personal outcomes are achieved within the most integrated setting by using identified supports and services. The ISP is supported by the results of the member’s program-specific assessment and must meet the requirements of 42 CFR §441.301.
Long-term Services and Supports (LTSS) — Services, including Primary Home Care, Day Activity and Health Services, and the STAR+PLUS HCBS program, that assist members in living in the community.
Medically Necessary
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
Network
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
Non-participating Provider
A provider who doesn’t have a contract with your health insurer or plan to provide covered services to you. It may be more difficult to obtain authorization from your health insurer or plan to obtain services from a non-participating provider, instead of a participating provider. In limited cases such as there are no other providers, your health insurer can contract to pay a non-participating provider.
Participating Provider
A Provider who has a contract with your health insurer or plan to provide covered services to you.
Personal Attendant Services
Attendants help individuals with activities of daily living, such as bathing, grooming, meal preparation and housekeeping. Attendants are trained and supervised by non-medical personnel.
Physician Services
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
Plan
A benefit, like Medicaid, to pay for your health care services.
Plan of care (POC) — A care plan the MCO develops for its members that includes acute care and LTSS. The POC is not the same as the ISP.
Pre-authorization
A decision by your health insurer or plan before you receive it that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval, or pre-certification. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
Premium
The amount that must be paid for your health insurance or plan.
Prescription Drug Coverage
Health insurance or plan that helps pay for prescription drugs and medications.
Prescription Drugs
Drugs and medications that by-law require a prescription.
Primary Care Physician
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.
Primary Care Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health care services.
Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional, or health care facility licensed, certified, or accredited as required by state law.
Rehabilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.
Service coordinator — The MCO staff person with primary responsibility for providing service coordination and care management to STAR+PLUS Members.
Skilled Nursing Care
Services from licensed nurses in your own home or in a nursing home.
Specialist
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
STAR+PLUS Home and Community Based Services (HCBS) program — Authority granted to the state of Texas to allow delivery of community-based LTSS that assist members to live in the community in lieu of an NF.
STAR+PLUS program — The State of Texas Access Reform Plus Medicaid managed care program in which HHSC contracts with MCOs to provide, arrange, and coordinate preventive, primary, acute and long term care covered services to adult persons with disabilities and elderly persons age 65 and over who qualify for Medicaid through the SSI program and/or the MAO program. Children under age 21, who qualify for Medicaid through the SSI program, may voluntarily participate in the STAR+PLUS program. The STAR+PLUS program is the umbrella designation that includes both the STAR+PLUS services and STAR+PLUS HCBS program.
Urgent Care
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
What are advance directives?
Advance directives are legal papers that allow you to say if you would accept or refuse medical treatment if you become too ill to speak for yourself. These papers can help your family decide what to do for you to relieve them of the stress of making the decision for you. It also helps the doctor care for you according to your wishes.
How do I get an advance directive?
Ask your doctor for the form(s) for advance directives. STAR+PLUS Members, call our Member Services toll-free at 1.888.760.2600 if you need more information.
How can I ask for a second opinion?
Please call our Member Services if you want a second opinion. You can get a second opinion from a network Provider or an out-of-network provider if a network Provider is not available. You may want to ask for a second opinion if:
When you go for your visit, tell the doctor you are there for a second opinion.
Member Services
Local: 713.295.2300 Toll-Free: 1.888.435.2850 | TTY 7-1-1 for Hearing-Impaired
24 hours a day, 7 days a week, Monday – Friday, excluding state-approved holidays. Access your Member account online 24 hours a day, seven days a week. Information is available in English and Spanish.
Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital. Also call for pharmacy and dental information.
Service Coordination Team
Local: 713.295.5004 Toll Free: 1.888.435.5150 | TTY 7-1-1 for Hearing-Impaired.
Service Coordination Team is available 8:00 am – 5:00 pm, Monday- Friday, excluding state approved holidays.
After business hours you can leave a message and calls will be returned within one business day or call Member Services hotline at 1.888.435.2850.
In case of an emergency, call 9-1-1 or go to the nearest hospital. If you have trouble hearing or speaking, please call the TTY/TDD line at 7-1-1
A referral is a consultation for evaluation and/or treatment of a patient requested by one doctor to another doctor. Community Health Choice will not pay the cost of non-emergency hospital care or medical equipment unless your Primary Care Provider gives you a referral.
Acute care — Preventive care, primary care, and other medical care provided under the direction of a provider for a condition having a relatively short duration.
Agency option (AO) — A service delivery option under which the provider is responsible for managing the day-to-day activities of the attendant and all business details.
Appeal
A request for your managed care organization to review a denial or a grievance again.
Community First Choice (CFC) option — Personal assistance services; habilitation services focused on the acquisition, maintenance and enhancement of skills; emergency response services; and support management provided in a community setting for eligible Medicaid Members in the STAR+PLUS Home and Community Based Services program who have received an institutional Level of Care (LOC) determination.
Community Living Assistance and Support Services (CLASS) — A non-capitated 1915(c) waiver which provides home and community–based services to individuals with intellectual or developmental disabilities.
Complaint
A grievance that you communicate to your health insurer or plan.
Copayment
A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.
Consumer Directed Services Employer – A member or legally authorized representative (LAR), parent, or court appointed guardian who chooses to participate in the CDS option and therefore is responsible for hiring and retaining service providers to deliver program services.
Consumer Directed Services (CDS) option — A service delivery option in which a member or LAR employs and retains service providers and directs the delivery of eligible STAR+PLUS Home and Community Based Services (HCBS) program services. A member participating in the CDS option is required to use a financial management services agency (FMSA) chosen by the member or LAR to provide financial management services.
Durable Medical Equipment (DME)
Equipment and supplies ordered by a health care provider for everyday or extended use. Coverage for DME may include: oxygen equipment, wheelchairs, crutches, or blood testing strips for diabetics.
Emergency Medical Condition
An illness, injury, symptom, or condition so serious that a reasonable person would seek care right away to avoid harm.
Emergency Medical Transportation
Ground or air ambulance services for an emergency medical condition.
Emergency Room Care
Emergency services you get in an emergency room.
Emergency Services
Evaluation of an emergency medical condition and treatment to keep the condition from getting worse.
Excluded Services
Health care services that your health insurance or plan doesn’t pay for or cover.
Grievance
A complaint to your health insurer or plan
Habilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, learn, or improve skills and functioning for daily living.
Health Insurance
A contract that requires your health insurer to pay your covered health care costs in exchange for a premium.
Home and community-based services (HCS) — A non-capitated 1915(c) waiver which provides home and community-based services to individuals with intellectual or developmental disabilities as cost-effective alternatives to institutional care.
Home Health Care
Health care services a person receives in a home.
Hospice Services
Services to provide comfort and support for persons in the last stages of a terminal illness and their families.
Hospitalization
Care in a hospital that requires admission as an inpatient and usually requires an overnight stay.
Hospital Outpatient Care
Care in a hospital that usually doesn’t require an overnight stay.
Individual service plan (ISP) — An individualized and person-centered plan in which a member enrolled in the STAR+PLUS HCBS program operated by the MCO, with assistance as needed, identifies and documents his or her preferences, strengths, and health and wellness needs in order to develop short-term objectives and action steps to ensure personal outcomes are achieved within the most integrated setting by using identified supports and services. The ISP is supported by the results of the member’s program-specific assessment and must meet the requirements of 42 CFR §441.301.
Long-term Services and Supports (LTSS) — Services, including Primary Home Care, Day Activity and Health Services, and the STAR+PLUS HCBS program, that assist members in living in the community.
Medically Necessary
Health care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.
Network
The facilities, providers, and suppliers your health insurer or plan has contracted with to provide health care services.
Non-participating Provider
A provider who doesn’t have a contract with your health insurer or plan to provide covered services to you. It may be more difficult to obtain authorization from your health insurer or plan to obtain services from a non-participating provider, instead of a participating provider. In limited cases such as there are no other providers, your health insurer can contract to pay a non-participating provider.
Participating Provider
A Provider who has a contract with your health insurer or plan to provide covered services to you.
Personal Attendant Services
Attendants help individuals with activities of daily living, such as bathing, grooming, meal preparation and housekeeping. Attendants are trained and supervised by non-medical personnel.
Physician Services
Health care services a licensed medical physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates.
Plan
A benefit, like Medicaid, to pay for your health care services.
Plan of care (POC) — A care plan the MCO develops for its members that includes acute care and LTSS. The POC is not the same as the ISP.
Pre-authorization
A decision by your health insurer or plan before you receive it that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary. Sometimes called prior authorization, prior approval, or pre-certification. Preauthorization isn’t a promise your health insurance or plan will cover the cost.
Premium
The amount that must be paid for your health insurance or plan.
Prescription Drug Coverage
Health insurance or plan that helps pay for prescription drugs and medications.
Prescription Drugs
Drugs and medications that by-law require a prescription.
Primary Care Physician
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) who directly provides or coordinates a range of health care services for a patient.
Primary Care Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates, or helps a patient access a range of health care services.
Provider
A physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine), health care professional, or health care facility licensed, certified, or accredited as required by state law.
Rehabilitation Services and Devices
Health care services such as physical or occupational therapy that help a person keep, get back or improve skills and functioning for daily living that have been lost or impaired because a person was sick, hurt or disabled.
Service coordinator — The MCO staff person with primary responsibility for providing service coordination and care management to STAR+PLUS Members.
Skilled Nursing Care
Services from licensed nurses in your own home or in a nursing home.
Specialist
A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat certain types of symptoms and conditions.
STAR+PLUS Home and Community Based Services (HCBS) program — Authority granted to the state of Texas to allow delivery of community-based LTSS that assist members to live in the community in lieu of an NF.
STAR+PLUS program — The State of Texas Access Reform Plus Medicaid managed care program in which HHSC contracts with MCOs to provide, arrange, and coordinate preventive, primary, acute and long term care covered services to adult persons with disabilities and elderly persons age 65 and over who qualify for Medicaid through the SSI program and/or the MAO program. Children under age 21, who qualify for Medicaid through the SSI program, may voluntarily participate in the STAR+PLUS program. The STAR+PLUS program is the umbrella designation that includes both the STAR+PLUS services and STAR+PLUS HCBS program.
Urgent Care
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
What are advance directives?
Advance directives are legal papers that allow you to say if you would accept or refuse medical treatment if you become too ill to speak for yourself. These papers can help your family decide what to do for you to relieve them of the stress of making the decision for you. It also helps the doctor care for you according to your wishes.
How do I get an advance directive?
Ask your doctor for the form(s) for advance directives. STAR+PLUS Members, call our Member Services toll-free at 1.888.760.2600 if you need more information.
How can I ask for a second opinion?
Please call our Member Services if you want a second opinion. You can get a second opinion from a network Provider or an out-of-network provider if a network Provider is not available. You may want to ask for a second opinion if:
When you go for your visit, tell the doctor you are there for a second opinion.
Member Services
Local: 713.295.2300 Toll-Free: 1.888.435.2850 | TTY 7-1-1 for Hearing-Impaired
24 hours a day, 7 days a week, Monday – Friday, excluding state-approved holidays. Access your Member account online 24 hours a day, seven days a week. Information is available in English and Spanish.
Call us to get an interpreter. In case of an emergency, call 9-1-1 or go to the nearest hospital. Also call for pharmacy and dental information.
Service Coordination Team
Local: 713.295.5004 Toll Free: 1.888.435.5150 | TTY 7-1-1 for Hearing-Impaired.
Service Coordination Team is available 8:00 am – 5:00 pm, Monday- Friday, excluding state approved holidays.
After business hours you can leave a message and calls will be returned within one business day or call Member Services hotline at 1.888.435.2850.
In case of an emergency, call 9-1-1 or go to the nearest hospital. If you have trouble hearing or speaking, please call the TTY/TDD line at 7-1-1
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
Medicaid
Health Plan
04/01/2027
Marketplace
Health Plan
03/01/2027
Copyright 2024 Community Health Choice. All Rights Reserved.