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

Authorization Process Updates—Therapy Services

Friday, October 28, 2016

FirstCare Health Plans is dedicated to ensuring our members get the care and services they need while exercising good stewardship in administering benefits properly. 
 
As a reminder, FirstCare Health Plans’ authorization process for Physical Therapy, Occupational Therapy and Speech Therapy requires submission of clinical information to demonstrate medical necessity.  When requesting therapy services, please include an evaluation or re-evaluation.  Additional clinical information may be requested.
 
For Medicaid Members:
Please reference your Texas Medicaid Provider Procedures Manual Vol. 2 - Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook for an overview of all standard requirements.  This handbook can be found at www.TMHP.com. Please review sections describing:

  • Frequency and Duration Criteria  (4.5)
  • Standardized Testing and Developmental Delay Criteria (5.3)
  • Requests for Recertification - every 180 days (5.2.5)
  • Patient and Caregiver Participation in Therapy and Home Program (5.2.5.1)
  • Functional Goals (4)
  • Criteria for Discontinuation of Therapy (4.6)
For all Members: 
Criteria for the above therapies is available upon request.
 
 
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

IMPORTANT—FirstCare Medicare Advantage Plan Changes

Wednesday, September 28, 2016

Our goal is to provide the best health plan solutions for our members while weighing the financial challenges of declining reimbursement and rising costs. It was difficult, but we made the decision to not renew our Medicare Advantage contract with The Center for Medicare & Medicaid Services (CMS) for 2017.
 
Our Medicare members will remain enrolled in their current FirstCare Advantage (HMO) coverage—and may obtain services—through December 31, 2016. However, they must choose a new plan for their coverage to continue in 2017. They have from October 15, 2016 – February 28, 2017, to make that selection. All FirstCare Advantage (HMO) members have been notified via letter for receipt no later than October 2, 2016. Copies of the letters are attached for your reference:

FirstCare will continue to pay claims for contracted providers in accordance with the contract and our claims filing guidelines.
 
This change does not impact any of FirstCare’s non-Medicare members or other lines of business. FirstCare remains committed to the communities we serve, as we work with you to play an important role in providing affordable health care coverage to West Texans.
 
And, as always, we appreciate your support.
 
If you have questions, please contact FirstCare Advantage (HMO) Customer Service at 1.866.229.4969 (TTY/TDD 1.800.562.5259). Our lines are open daily Oct. 1 - Feb. 14, from 8 a.m. - 8 p.m. From Feb. 15 - Sept. 30, our lines are open from 8 a.m. - 8 p.m. CT, Monday through Friday. You may also 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

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 12/6/2016 FirstCare Medical Pharmacy Authorization Requirements Updated 12/1/2016 FirstCare DME Authorization Requirements Updated 11/1/2016 FirstCare Behavioral Health Authorization Requirements Effective 8/25/2016 Providence (SmartHealth) Pre-Certification List Effective 1/1/2016


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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