COVID-19 Update: We’re here for you.
As we continue to monitor the spread of COVID-19, we are committed to keeping you informed. Customer advocates are available by phone, as always. Click here for more information and benefit updates.

Effective March 6, 2020, and until further notice, FirstCare Health Plans is waiving member cost-sharing for care related to COVID-19, which includes testing, telehealth services, outpatient office visits and inpatient hospital stays. This applies to fully insured Commercial and Medicare Advantage Dual SNP members. Members of self-funded employer groups should contact their Human Resources Department for information on covered benefits.
Provider/Physician Notice
View the COVID-19 Telehealth and Telemedicine Policy for coding guidelines and claims submission procedures. We have also reduced our Prior Authorization Requirements.
Provider Update: Member cost-share waiver for COVID-19 care
Effective March 6, 2020, and until further notice, FirstCare Health Plans is waiving member cost-sharing for care related to COVID-19, which includes testing, telehealth services, outpatient office visits and inpatient hospital stays.  This applies to fully insured Commercial and Medicare Advantage Dual SNP members; self-funded customers may also elect to implement this coverage for their employees. Cost-sharing does not apply to Medicaid members.
CMS Hospital Without Walls Initiative
The Health and Human Services Commission (HHSC) adopted emergency rules in response to the state of disaster declared in Texas and the United States of America related to COVID-19. As part of the CMS Hospital Without Walls initiative, hospitals can provide hospital services in other healthcare facilities and sites not currently considered to be part of a healthcare facility or set up temporary expansion sites to help address the urgent need to increase capacity to care for patients, in response to the COVID-19 pandemic. Additional information is available here.

Providers

Effective January 1, 2019, Scott and White Health Plan, part of Baylor Scott & White Health, acquired FirstCare Health Plans. The acquisition allows two provider-owned health plans to come together to create a more comprehensive and sustainable insurer with a driving focus on enhancing the customer experience through advanced technology. 

For more information, visit FirstCare.com/SWHP.
 

Interested in Becoming a New Provider?

We’re always looking for exceptional providers to join our growing network of physicians and hospitals. Together, we can help you give your patients—and our members—the quality, cost-efficient care they deserve. Click here to learn more.
 

Contact Your FirstCare Provider Relations Team

Our Provider Relations Team is here for you. If you have questions or need support, please click here to find contact information.


Corporate Medical Advisory Committee (CMAC)

The Corporate Medical Advisory Committee (CMAC) develops, reviews and approves clinical programs and guidelines, studies, and other clinical activities related to the health care services provided to FirstCare members.

 



Provider News

October 2020 NDC-to-HCPCS Crosswalk Now Available

The quarterly NDC-to-HCPCS Crosswalk is now available for clinician-administered drug processing. The next new crosswalk will be available January 2021.

Click here for information. 

Branded Concerta Tablets Return to Non-Preferred Status on October 16, 2020

FirstCare follows the Texas VDP formulary. VDP temporarily removed the non-preferred status for brand Concerta products in the Stimulants drug class on April 23, 2020 in response to reported drug shortages. VDP will reverse this change in status because of sufficient availability in the market. VDP made this determination after verifying the current availability of the preferred Methylphenidate ER tablet products, as well as the non-preferred brand Concerta products through multiple sources such as ASHP, FDA, manufacturers, wholesalers, and pharmacies in various regions around Texas.

VDP will restore the non-preferred status on the drugs below on October 16, 2020 because of sufficient product availability. For a complete list of all preferred products in the Stimulants drug class, refer to the July 2020 Preferred Drug List. Contact vdp-formulary@hhsc.state.tx.us (link sends e-mail) for questions or comments.

For additional information and a list of preferred PDL NDCs, please click here.

View all provider news >

We're here to help.

Our Provider Relations Team is here for you. If you have questions, please click here to find contact information.


The National Committee for Quality Assurance (NCQA) awarded FirstCare Health Plans an Accredited Status (Commercial, Medicaid and Marketplace HMO, recertified 02/2018)—reflecting our continuous work to fulfill NCQA requirements for consumer protection & quality improvement.

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