CHIP Complaints and Appeals Process

When you have a problem, call Customer Service at 877-639-2447. They can provide assistance and may be able to resolve your problem while you are on the phone or within days of your call.

CHIP Complaint and Appeals Process Guide
This document contains information on how to make a complaint or file an appeal if you are a CHIP member.

You can report a problem over the phone or in writing and we will respond within 5 days. If you tell us the problem by phone, we will send you a one page form to complete and return. If you inform us of a problem, we will write you back with the date we received your letter. This date is important because we have thirty (30) days to make a decision on your complaint.

Appeals

If you are not satisfied with the outcome, you can appeal. You have the right to appeal at any time during this process. You have only 180 days from the date on the letter to file an appeal. If you do not file your appeal within 180 days, you forfeit the right to appeal. The appeal is not a court of law.

You may request an appeal by calling Customer Service or the Department of Insurance:

Texas Department of Insurance
P.O. Box 12030
Austin, TX 78711
Phone: 800-252-3439
Fax: 512-475 1771
Website: www.tdi.texas.gov
Email: consumerprotection@tdi.state.tx.us

If FirstCare informs you that your child received services that were not medically necessary and you do not agree, you are entitled to request an independent review.

If you have questions, call Customer Service at 877-639-2447.

Member Portal

Log In/Register

Authorization Information

Access authorization information

Find a Provider

Access the CHIP provider directories:

Need Help?
Contact Us!

Call FirstCare CHIP Customer Service at 1-877-639-2447.

We're open from 8 a.m. to 5 p.m. weekdays, excluding state approved holidays. If you call after hours, please leave us a message. We return all calls the next business day.

Our Customer Service Representatives speak English and Spanish. If you speak another language, we can connect you with an interpreter. You can get information in larger print, audio (CD), braille or in any other language format if needed. For help, call FirstCare CHIP Customer Service at 1-877-639-2447.

Members with hearing loss can call the Relay Texas number 711. Relay Texas is a free telephone interpreting service to help people with hearing or speech disabilities.

Resources

CHIP Service Area CHIP Member News

Talk to a Nurse—Nurse24™

Need care advice? Have a medical question? Not sure if you should see a doctor? For non-emergency symptoms and health or treatment questions, FirstCare Members have access to talk with a nurse 24/7. Get the information you need any time of the day or night by calling 1-855-828-1013. Information is available in English and Spanish. Interpreter services available upon request. TTY users can call 7-1-1.

Utilization Management

Ever wonder how we decide to authorize services? Our decisions are based on medical evidence and consensus of health care professionals. For more details, click here.

Scrubbing In

A NEW alternative to Grow Well

We invite you to explore Scrubbing In, weekly wellness advice for all life stages, to help keep you and your family healthy and at your best.
NOTE: Scrubbing In offers a provider search tool that may not apply to your Medicaid coverage.

Find a provider who accepts FirstCare STAR or CHIP
Read the Scrubbing In blog on the web or download the MyBSWHealth app
download the my b s w health app

Helpful Links and Phone Numbers

CHIPInformation and Referral:
2-1-1 or 1-877-541-7905
Enrollment Helpline: 1-800-964-2777
TTY: 1-800-735-2989 
MCNA Dental (CHIP)Medicaid & CHIP dental plan for Texas
1-855-691-6262
TTY: 1-800-955-8771
DentaQuest (CHIP)Medicaid & CHIP dental plan for Texas
1-800-508-6775
TTY: 1-800-855-2880
United DentalMedicaid & CHIP dental plan for Texas
1-877-901-7321
TTY: 711
Navitus Health SolutionsFirstCare’s Pharmacy Benefit Manager 
1-877-908-6023
TTY: 711
OCCC Financial Literacy Information1-800-538-1579

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