Providers

Why work with FirstCare?

Like you, we are deeply committed to doing the right thing for the health of our communities. FirstCare is Texas-based and provider-owned, so we know what it means to deliver quality care, right here. We want doctors to be in charge of patient care. We’ll do everything we can to help you achieve better patient outcomes.
 
Partnering with FirstCare can connect you with more than 1,200 contracted facilities, including 115 hospitals, and more than 12,000 other contracted providers. Our strong local ties can generate favorable new business — from commercial to government-employed patients — all at competitive, profitable rates. FirstCare has tremendous expertise in compliance, administration, and processing for STAR, CHIP, Medicare and FEHB programs. And we do it all with high ease of use, high reliability and low administrative hassle.

Learn More About Becoming a Provider >

 

 

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

New Documentation Tools for Texas Health Steps Providers

Tuesday, January 31, 2017

As a Texas Health Steps (THSteps) provider, you affect the lives of many young Texans, and the Health and Human Services commission (HHSC) understands documenting the THSteps components of the checkup can be challenging.  HHSC would like to assist you in documenting all of the required components and elements of the THSteps checkups in order to reflect the work you perform to complete each checkup. 
 
The following documents can be used as resources to assist you in completing THSteps checkup documentation:


For more information, please email your provider relations representative at Provider_Relations@firstcare.com or call the number below:
  • Abilene area:               1.325.670.3525
  • Amarillo area:              1.800.239.5650
  • Lubbock area:             1.806.784.4380
  • All other areas:            1.800.431.7737

2017 HCPCS Updates for Texas Medicaid Physical and Occupational Therapy

Tuesday, January 31, 2017

Effective for dates of service on or after January 1, 2017, physical therapy (PT) evaluation procedure code 97001 and re-evaluation procedure code 97002, and occupational therapy (OT) evaluation procedure code 97003 and re-evaluation procedure code 97004 are being discontinued by the 2017 Healthcare Common Procedure Coding System (HCPCS) code updates.
 
The new 2017 HCPCS physical therapy evaluation procedure codes 97161, 97162, and 97163 will replace discontinued procedure code 97001. Occupational therapy evaluation procedure codes 97165, 97166, and 97167 will replace discontinued procedure code 97003.
 
The three replacement evaluation codes for each discipline's previous single evaluation code reflect the complexity level of the evaluation performed. Providers may only choose one of the three codes. 
 
The therapist who performs the evaluation should use professional clinical judgement to decide which evaluation procedure code to use. The selection must be based on professional clinical judgement and may not be made by staff other than the rendering therapist.

Documentation of the therapist's evaluation must be kept in the client's record and must:

  • Include a signed and dated physician's order for the evaluation.
  • Support a medical need for the therapy evaluation.
  • Be available when requested.

For more information, please email your provider relations representative at Provider_Relations@firstcare.com or call the number below:
  • Abilene area:               1.325.670.3525
  • Amarillo area:              1.800.239.5650
  • Lubbock area:             1.806.784.4380
  • All other areas:            1.800.431.7737

View all provider news >

We're here to help.

Our Provider Relations Team is here for you. If you have questions, please email Provider_Relations@FirstCare.com, or contact your provider relations representative at the number below:
  • Abilene area—1.325.670.3525
  • Amarillo area—1.800.239.5650
  • Lubbock area—1.806.784.4380
  • All other areas—1.800.431.7737

Resources

Care Management Services

Authorization Requirements
FirstCare Authorization Requirements Matrix Updated 2/14/2017 FirstCare Medical Pharmacy Authorization Requirements Updated 1/12/2017 FirstCare DME Authorization Requirements Updated 2/1/2017 FirstCare Behavioral Health Authorization Requirements Effective 1/12/2017 
Referrals & Case Management
Making Referrals & Working with FirstCare Case Management Updated 1/11/2017


The National Committee for Quality Assurance (NCQA) has awarded an accreditation status of Accredited for service and clinical quality that meet the basic requirements of NCQA's rigorous standards for consumer protection and quality improvement.

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