Important Forms & Information

Below are resources and information FirstCare providers can access for medical authorizations, behavioral health services, pharmacy needs, reimbursement policy forms and more.

Medical Forms

Prior authorization requests, authorization check lists, treatment forms, clinical data forms, and more.

Behavioral Health Forms & Information

Forms and information for behavioral health services.

Pharmacy Information

Prescription drug formularies, enrollment forms (specialty and mail order pharmacy), etc.

As of 09.01.2019 TRS-ActiveCare Patients will be using a new PBM - click here for details.

Reimbursement Policies & Forms

Documents and forms related to provider reimbursements for health care services.

Case Management/Disease Management Referrals

Telemedicine Medical Services & Telehealth Services

Any contracted FirstCare provider can provide telemedicine medical services and/or telehealth services, for certain circumstances and conditions, to a FirstCare member.
  • No pre-authorization is required by an in-network FirstCare provider. However, if an out-of-network provider is needed, pre-authorization is required. In these cases, FirstCare requires a 48-hour advance notice prior to the member receiving telemedicine services from an out-of-network provider.
  • Covered services are subject to all applicable copayments, coinsurance, and deductible amounts, not exceeding those for the same covered service provided in an in-person location such as a doctor’s office, clinic, or hospital.
  • Telemedicine provider reimbursement is related to the type of medical provider, complexity of care delivered, and the place of service. For more information, please refer to your FirstCare provider contract.
If you have any questions, contact your FirstCare Provider Relations Representative.


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