Introducing: The New CommunityCare Connect Mobile App view more

We are excited to introduce the CommunityCare Connect mobile app for our health plan members! View your member ID card, benefits, deductible information, medical visits, claims and more. CommunityCare Connect is available in the Apple Store and Google Play.

Get information about your medical and pharmacy claims

Check your current deductibles

Find information about your plan benefits

Quick and easy access to your account information

Download or reorder your Member ID card

Set up your online account in a snap

Payment Policies

CommunityCare Claim Payment Policies - Commercial Products

CommunityCare's claim payment policies are designed to assist health care providers when submitting claims, and provide information on how CommunityCare generally adjudicates a claim for the referenced item or service. These policies are subject to change at any time.

Any conflict between a payment policy, the provider's contract with CommunityCare, CommunityCare's Provider Manual, and health plan enrollee's individual or group benefits will be resolved in the following order:

  1. the enrollee's benefits;
  2. the provider's contract;
  3. the Provider Manual; then
  4. the payment policy.

These payment policies are not a guarantee of payment with respect to any particular claim. Claim payment is subject to patient eligibility for coverage on the date of service, the availability of other coverage (e.g., third-party liability or other group or individual coverage), the plan's utilization management and review requirements (e.g., prior authorization; retrospective review for medical necessity; proper coding) and claim editing logic (i.e., to detect improper bundling, unbundling or upcoding).

Before accessing, please confirm you agree with the terms of use as outlined above.