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 4,600 contracted facilities, including 199 hospitals, and more than 16,400 primary care and specialty 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 and CHIP programs. And we do it all with high ease of use, high reliability and low administrative hassle.

Learn More About Becoming a Provider >

 

Contact Your FirstCare Provider Relations Team

Our Provider Relations Team is here for you. If you have questions, please contact your provider relations representative:

Region Phone Email
Abilene 325.670.3882
325.670.3884
 
prabilene@firstcare.com
Amarillo 806.467.3200
 
prsupport@firstcare.com
Lubbock, Waco and
all other areas
806.784.4380 prlubbock@firstcare.com
       

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

Medicaid—Anesthesia Reimbursement Benefit Language Clarified for Texas Medicaid, Effective 05/01/2018

Wednesday, Apriil 4, 2018

 
Effective for dates of service on/after May 1, 2018, anesthesia reimbursement benefit language will be clarified for Texas Medicaid.
 
Anesthesia Reimbursement Benefit Language Clarifications
The following will be clarified in the Texas Medicaid Anesthesia Reimbursement benefit policy:
  • An anesthesia practitioner is defined as an anesthesiologist who performs the anesthesia service alone or medically directs a certified registered nurse anesthetist (CRNA), anesthesiologist assistants (AA) or other qualified professional.
  • When a single claim per client is billed by the anesthesiologist for medically directing anesthesia services of an anesthesia procedure provided by one CRNA, AA or qualified professional, the QY and U1 modifier combination must be billed together when the CRNA, AA or qualified professional is part of a clinic or group.
  • Modifiers QZ and U1 must be submitted when a CRNA has personally performed the anesthesia services, is not medically directed by the anesthesiologist and is directed by the physician. 
  • Epidural and subarachnoid infusion (not including labor and delivery): 
    • Epidural and subarachnoid infusion for pain management is payable for acute, chronic and postoperative pain management; 
    • Procedure code 01996 is payable to CRNAs and physicians and is limited to once per day and will be denied when billed on the same day as a surgical/anesthesia procedure; and 
    • Procedure code 01996 billed longer than 30 days requires medical necessity documentation. Cancer diagnoses are excluded from the 30-day limitation.
   
 

FirstCare Awarded Recertification of its NCQA Accredited Status

Monday, March 19, 2018

 
We are pleased to announce that the National Committee for Quality Assurance (NCQA) recently awarded full, three-year Accredited status again to FirstCare’s HMO lines of business (i.e., Commercial, Medicaid, Medicare, and Marketplace). Effective 02/16/2018, this accreditation runs through 02/16/2021. As with our original accreditation in 2015. we pursued this accreditation because of our commitment to the highest quality health care for our more than 170,000 members throughout 108 counties in North, West and Central Texas.
 
NCQA Accreditation recognizes FirstCare’s ongoing commitment to providing quality health care to our members as health plans earning this accreditation are shown to outperform non-accredited health plans across a wide range of measures, including clinical quality and member satisfaction.
 
Our accreditation status was awarded after rigorous evaluation by NCQA of all aspects of our plan, including preventive health services, member satisfaction, physician credentialing and quality improvement.
 
If you have any questions, please contact your FirstCare Provider Relations Representative at:
 
Region Phone Number Email
Abilene 325-670-3882
325-670-3884
CHaterius@firstcare.com
RRussel@firstcare.com
Amarillo 806-467-3200 prsupport@firstcare.com

Lubbock, Waco and
all other areas

806-784-4380 prlubbock@firstcare.com

 



 

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—1.325.670.3882 or 1.325.670.3884
  • Amarillo area—1.806.467.3200
  • Lubbock, Waco & other areas—1.806.784.4380

Resources

Accessing the FirstCare Provider Self-Service Portal
Authorization Requirements
FirstCare Authorization Requirement Changes Effective 11/1/2017 
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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