Provider News

Notice to Physicians and Providers (per TAC § 11.1402)

Tuesday, January 30, 2018

 
SHA, L.L.C. dba FirstCare, 12940 N. Hwy 183, Austin, TX 78750, a basic health service, individual practice model health maintenance organization, will accept written applications during the period of February 1, 2018, through February 20, 2018, from physicians and providers who wish to participate in the FirstCare network. FirstCare offers services for the following products:  STAR Medicaid and CHIP, Commercial and Federal Marketplace. Marketplace applicants must FirstCare’s practice standards and qualifications for acceptance. Applicants will be notified in writing of acceptance or non-acceptance within 90 days after FirstCare receives an application for participation. Applications should be sent to the attention of the Provider Relations Department.

IMPORTANT—Upcoming Changes to Out-of-Network Lab Coverage

Friday, January 26, 2018

 
At FirstCare, we strive to make our health plans affordable and reduce out-of-network utilization. As such, the following changes will go into effect on March 1, 2018:
  • FirstCare HMO members will no longer be covered for unauthorized lab services (i.e., blood tests, biopsies, etc.) when provided by out-of-network lab providers.
  • FirstCare PPO members will no longer receive in-network benefits for unauthorized lab services billed from out-of-network providers.
Please remember that all FirstCare Health Plans participating providers have an obligation to refer FirstCare members to other in-network providers for services, including labs. If your practice currently uses a lab that is not in the FirstCare provider network, or if you refer FirstCare members to an out-of-network lab, please consider how this results in higher health care costs for your patients.
 
In the next few weeks, you will receive a letter with more details on this change, as well as a list of in-network laboratory providers for your patients covered by a FirstCare plan.
 
If you have any questions—or if you need additional information regarding in-network options for laboratory services—please contact the FirstCare Provider Relations team.
 
Thank you for your continued support and dedication to our members.

CHIP—REMINDER: CHIP Providers Must Enroll with TMHP by 12/31/17 to Continue Receiving Reimbursement for CHIP Services

Wednesday, December 27, 2017

 
Federal law and regulation require states to screen and enroll all network providers including Children’s Health Insurance Program (CHIP) providers by December 31, 2017. To meet this requirement and continue receiving reimbursement for services, providers who currently render services to CHIP members through a managed care organization (MCO) must complete enrollment with the Texas Medicaid & Healthcare Partnership (TMHP) by December 31, 2017.
 
While the enrollment process and application are the same for Medicaid and CHIP providers, CHIP-only providers are not required to participate in Texas Medicaid. CHIP-only providers must follow the instructions below to indicate they intend to serve only CHIP members and to ensure that they do not appear on the Medicaid online provider lookup (OPL).
 
NOTE: CHIP providers actively enrolled with TMHP as a Medicaid provider do not need to repeat the enrollment process to continue to receive reimbursement for CHIP services. 


Enrollment Information Specific to CHIP Providers
 
Beginning July 1, 2017, providers can indicate in the enrollment application that they intend to serve only CHIP members. Providers must document this appropriately to ensure they are not displayed as a Medicaid provider on OPL.
 
CHIP providers are encouraged to enroll using the Provider Enrollment on the Portal (PEP). Additionally, the Provider Information Management System (PIMS) will be updated with options for providers to designate that they intend to serve only CHIP members.
 
Providers should begin the enrollment process as soon as possible. The PIMS update will allow providers who start the enrollment process before these updates occur, to designate themselves as CHIP-only providers on the OPL after they are enrolled.
 
For more information, providers should visit the upcoming CHIP webpage that will be added to TMHP.com in the next few weeks.
 
For more information, call the TMHP Contact Center at 1-800-925-9126.

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