Community Health Direct Providers: Community Gold, Silver, Bronze Plans
2020 forms should be used starting on 1/1/20. Please download new forms below.
Community Health Direct is accepting Other Payer Primary COB information within your electronic claims. Please submit Primary Other Payer processing information using HIPAA-standard codes and amounts at the line-item detail level within your electronic claim files. Electronically submitted Primary COB information is processed at initial adjudication, and eliminates secondary paper claim and paper primary EOB submission requirements when Community Health Direct is the secondary payer.
Community Health Direct is accepting EFT/835 enrollment. Please submit the completed 835/EFT enrollment forms to Tina Smith at 317-806-5408 (fax) or tsmith@eCommunity.com.
- Preferred Formulary Medication List and Exclusion List
- Drug Exclusion List (medications not covered under Community Health Direct health plans)
- Silver Members: 2020 Preventive Medication List
- Affordable Care Act Zero Dollar Medication List
- Access90 Program
- Anti-Obesity Medication Coverage Guidelines
- Prescription Reimbursement Request Form Note: This form is NOT for HSA/HRA reimbursements)
- Summary of 2020 Pharmacy Benefits
Main line: 317-621-7575 or 800-344-8672
Customer service: 317-621-7565
Medical management: 317-621-7546
Provider relations: 317-621-7581
Claims Mailing Address:
P.O. Box 50407
Indianapolis, IN 46250
Electronic Claims: Web ID# 35161