IFP Provider Resources
IFP Exit
IFP Provider Business Resources
Effective January 1, 2026, Chorus Community Health Plans (CCHP) has officially exited the Affordable Care Act (ACA) Marketplace, discontinuing our Individual and Family Plan (IFP) product.
We extend our sincere gratitude to our provider partners for delivering exceptional care to CCHP IFP members since we entered the IFP/ACA market in 2017.
As you work to process remaining IFP claims and close outstanding business, you’ll find several resources below to assist you.
Contacts and Claims
We strongly encourage you to submit all CCHP IFP/ACA Marketplace claims in a timely manner. Doing so will ensure prompt processing and payment.
Services provided on 1/1/26 and after will not be covered by CCHP’s IFP/ACA Marketplace product. This includes services that were prior authorized in 2025. All services must be rendered on or before 12/31/25 to be covered.
IFP Provider Customer Service
800-201-4672
Electronic Claims:
EDI Payer ID: 251CC
Paper Claims address:
Chorus Community Health Plans
PO Box 106013
Pittsburgh, PA 15320-6013
Claims Appeals:
Submit the Provider Appeal/Claim Review Request Form along with copies of any supporting documentation.
Chorus Community Health Plans
Attn: Appeals Department
PO Box 1997, MS6280
Milwaukee, WI 53201
Email Provider Relations at cchp-providerappeals@chorushealthplans.org.
Corrected Claims:
CMS 1500 should be stamped as a corrected claim.
UB04: Corrected claims should be billed with the correct bill type.
Forms:
Provider Appeal/Claim Review Request Form
Provider Appealing on Behalf of Member -
The IFP provider portal is no longer accessible as of December 31, 2025. For assistance with member eligibility, claim status or other IFP/ACA Marketplace related inquiries please contact Provider Services at 844-202-0117.
Authorizations and Coverage and Limitations
Authorizations
IFP/ACA Marketplace Authorizations submitted through the authorization portal will be reviewed through 12/31/25.
View details about the GuidingCare Auth Portal which allows users to submit and/or access authorizations.
IFP Coverage and Limitation List
2025 Coverage and Limitation list
2025 IFP Medication List
PrEP Therapy Treatment Guidance
Members who are actively undergoing PrEP therapy treatment can receive certain baseline and monitoring services at no cost. For members to receive these services without cost-share, billing must include one of three following diagnosis codes and/or modifier 33:
- Z20.6 (contact with or exposure to human immunodeficiency virus (HIV))
- Z29.81 (encounter for HIV pre-exposure prophylaxis)
- Z79.899 (other long term (current) drug therapy
View the CPT code guide below to access the full list of services applicable to processing PrEP therapy treatments for members.
View PrEP Therapy CPT codes.
Step Therapy Protocol
CCHP utilizes a step therapy process to ensure our members can get the medication they need at the most reasonable cost. Step therapy is the practice of using specific medications first when beginning drug therapy for a medical condition. Step therapy is a type of prior authorization. In most cases, the preferred first course of treatment may be a generic drug(s) or drug(s) that is considered as the standard first-line treatment. Preferred first courses of treatment are also standard clinical practice and based on clinical practice guidelines. When trying to fill a drug that is part of a step therapy protocol, it may be automatically approved if your records show that you have already tried the preferred first course of treatment. If there is no record of you having tried the preferred first course of treatment, your physician must submit relevant clinical information to the CCHP Pharmacy Department to determine if the requested drug will be covered.
If you feel that an exception to the step therapy process should be granted, your provider may file an exception request by completing the Medication Authorization Form.
Read all the details on the IFP Exit on the FAQ page