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.
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

National Academy of State Health Policy Provider Survey

HHSC is participating in the National Academy of State Health Policy (NASHP) Maternal Child Health Policy Innovation program and is seeking provider input to gain a better understanding of the current landscape for substance use identification, substance use disorder (SUD) treatment, and referral practices for pregnant and postpartum women enrolled in Medicaid, CHIP (including CHIP-P) or the Healthy Texas Women Program. Your response to the below survey will assist HHSC in developing better training and communication around SUD identification, existing treatment benefits, as well as referral and intervention processes, and analyzing whether benefit and policy changes are needed.

The survey can be found here and is available until August 31, 2020.

Status of Generic Albuterol Products Return to Non-preferred August 28, 2020

In response to reported drug shortages for albuterol products in the Bronchodilators, Short-Acting Beta Agonist Inhalers drug class, FirstCare temporarily removed the non-preferred status from the generic formulations on March 20, 2020. FirstCare will reverse this change in status because we determined sufficient availability in the market. For more information including the preferred PDL options, 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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