Community First Insurance Plans Prior Authorization

Community First Insurance Plans prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Community First uses the Provider Portal for prior authorization requests and status review. For Medicaid/CHIP, the plan publishes general timelines and a process for incomplete requests, including a 3-business-day letter and peer-to-peer opportunity. For inpatient/non-participating services, the plan requires timely notification and, in some cases, prior authorization. Medicare Advantage publishes a line-specific PA list and requires requests no less than 5 business days before the start of service for listed services. Pharmacy PA has separate Navitus processes and timelines.
• Requirements vary by line of business and service type.
• The published Medicaid page is not all-inclusive; it directs providers to the Provider Quick Reference Guide for plan-specific phone and fax numbers.
• Emergency care does not require authorization.
• Non-participating provider referrals require prior authorization and must be requested by a participating physician.
• For inpatient admissions, notification within 24 hours is required even when prior authorization is also required for certain scenarios.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3
• Verification resource 4

How to submit prior authorization requests

• Provider Portal prior authorization request form

• Phone assistance for prior authorizations

• Pharmacy prior authorizations through Navitus (prescriber office call / pharmacy process)

• Submission resource 1

Information commonly required

• Member ID number
• Provider name and address
• Date of service
• Reference and/or claim number when relevant to reconsideration/appeal
• Medical records
• Lab reports
• Radiology reports
• Any other pertinent medical necessity documentation
• Prior authorization number when appealing a denial for prior notification/prior authorization information

Turnaround notes and caveats

• Medicaid/STAR/STAR Kids authorization requests: within 3 business days from receipt.
• CHIP: within 2 business days for approval and 3 business days for denial.
• For incomplete outpatient requests, Community First issues a 3-business-day letter and may refer for medical director review no later than 7 business days after the original receive date; final decision no later than the 10th business day after receive date.
• Pharmacy PA: immediate if prescriber’s office calls Navitus for Medicaid/CHIP; otherwise no later than 24 hours after receipt for other Medicaid PA requests.
• Medicare Advantage PA list: initial requests should be submitted no less than 5 business days before the start of service.
• Requirements vary by line of business and service type.
• The published Medicaid page is not all-inclusive; it directs providers to the Provider Quick Reference Guide for plan-specific phone and fax numbers.
• Emergency care does not require authorization.
• Non-participating provider referrals require prior authorization and must be requested by a participating physician.
• For inpatient admissions, notification within 24 hours is required even when prior authorization is also required for certain scenarios.

Provider resources

• Community First Provider Portal (official)
• Medicaid Provider Prior Authorizations (official)
• Authorization Notice for Participating and Non-Participating Physician and Provider Services (official)
• Claim Appeals: Quick Reference Guide (official)
• Claim MD Now Available (official)
• Medicare Advantage Alamo and D-SNP 2025 Prior Authorization List (official)
• Provider Support Line Now Available (official)

Sources