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.

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Provider News

New Customer Service Hours—Effective 08/08/16

Wednesday, July 27, 2016

As we constantly evaluate and enhance our Customer Service call center for efficiency and improvements in managing call volume, we wanted to share that effective Monday, August 8, 2016, we will transition to new Customer Service hours for our commercial lines of business. These new business hours will be Monday through Friday, 8 a.m. to 5 p.m. CT.
We anticipate minimal impact to our commercial HMO/PPO, Marketplace and Administrative Services members and providers as we currently average less than two percent of calls between 5 p.m. – 6 p.m. This change is in line with other lines of business and allows us to better align our customer service resources during critical business hours.
You can still visit the FirstCare Provider Self-Service portal ( for 24/7 access to information and resources.
If you have any questions, please email the FirstCare Provider Relations team at or contact your FirstCare 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

Texas Medicaid Providers—Reminder for Re-Enrollment/Revalidation Deadline of Sept. 25, 2016

Wednesday, June 22, 2016

As mentioned back in January 2016, CMS extended the deadline for Medicaid provider re-enrollment to Sunday, September 25, 2016.
In March, the State of Texas had requested that Medicaid providers apply for re-enrollment no later than Friday, June 17, 2016, to be assured that they would not be dropped from being a Texas Medicaid provider.
Due to the expiration of that deadline, Texas Medicaid will continue to normally process complete applications received on or after June 17, 2016; however, Texas Medicaid cannot guarantee that those applications will be completely processed by the September 24, 2016 deadline. If final approval on an application received after June 17, 2016, is not completed by September 24, 2016, the provider will be dis-enrolled from Texas Medicaid. Providers including, but not limited to, ordering and referring providers, will be dis-enrolled from Texas Medicaid with an effective date of September 25, 2016 if the application is received after June 17, 2016, and a final determination on the application is pending. Though these applications will continue to be processed, a gap in enrollment will exist between September 25, 2016, and the date the application is approved. Providers whose applications are denied will remain dis-enrolled as of September 25, 2016, and will not be eligible to receive reimbursement for claims with dates of service during the time the provider is not enrolled in Texas Medicaid. If the re-enrollment application is approved at a later date, the re-enrollment date will be the date the application was approved—not retroactive to the date the provider was dis-enrolled. Additionally, dis-enrolled providers will not be eligible to participate in Medicaid managed care organizations (MCOs) or dental maintenance organizations (DMOs) during the dis-enrolled period.
This re-enrollment requirement applies to all providers participating in Medicaid managed care, traditional fee-for-service Medicaid (each active TPI Suffix), the Texas Vendor Drug Program (VDP), and in long term care services administered through the Texas Department of Aging and Disability Services (DADS).
For more information, please call the TMHP Contact Center at 1.800.925.9126 (select "Option 2") or the TMHPCSHCN Services Program Contact Center at 1.800.568.2413.
If you have questions, please email the FirstCare Provider Relations Team at

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Care Management Services

Authorization Requirements
FirstCare Authorization Requirements Matrix Updated 8/11/2016 Spinal Care and Rehabilitation Authorization Requests (Includes other new codes too) Effective 10/1/2016 FirstCare Medical Pharmacy Authorization Requirements Updated 8/29/2016 FirstCare DME Authorization Requirements Updated 6/29/2016 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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