Verifying Eligibility
As we transition to a new claims system, the correct portal to verify eligibility will vary by member. Most members can be verified through swhpprovider.firstcare.com. Otherwise, please visit portal.swhp.org/providerportal. Note that the applicable provider portal is listed on the member’s ID card.
COVID-19 Vaccine
The COVID-19 Vaccine will be available to health plan members at zero out-of-pocket cost. Click here for more information and benefit updates.
COVID-19 Testing/Treatment: Effective March 6, 2020, and until further notice, FirstCare Health Plans is waiving member cost-sharing for care related to COVID-19, which includes testing, telehealth services, outpatient office visits and inpatient hospital stays. This applies to fully insured Commercial and Medicare Advantage Dual SNP members. Members of self-funded employer groups should contact their Human Resources Department for information on covered benefits.
Provider/Physician Notice
View the COVID-19 Telehealth and Telemedicine Policy for coding guidelines and claims submission procedures. We have also reduced our Prior Authorization Requirements.
Provider Update: COVID-19 Vaccine
As part of our ongoing fight against the global pandemic, FirstCare and its self-funded groups will be covering the cost of administering COVID-19 vaccines with zero cost-share for our members. This applies to fully insured and self-funded commercial members, as well as our Medicare and Medicaid members. Find out more here.

COVID-19 TESTING/TREATMENT: Effective March 6, 2020, and until further notice, FirstCare Health Plans is waiving member cost-sharing for care related to COVID-19, which includes testing, telehealth services, outpatient office visits and inpatient hospital stays. This applies to fully insured Commercial and Medicare Advantage Dual SNP members; self-funded customers may also elect to implement this coverage for their employees. Cost-sharing does not apply to Medicaid members.
CMS Hospital Without Walls Initiative
The Health and Human Services Commission (HHSC) adopted emergency rules in response to the state of disaster declared in Texas and the United States of America related to COVID-19. As part of the CMS Hospital Without Walls initiative, hospitals can provide hospital services in other healthcare facilities and sites not currently considered to be part of a healthcare facility or set up temporary expansion sites to help address the urgent need to increase capacity to care for patients, in response to the COVID-19 pandemic. Additional information is available here.

Providers

Effective January 1, 2019, Scott and White Health Plan, part of Baylor Scott & White Health, acquired FirstCare Health Plans. The acquisition allows two provider-owned health plans to come together to create a more comprehensive and sustainable insurer with a driving focus on enhancing the customer experience through advanced technology. 

For more information, visit FirstCare.com/SWHP.
 

Interested in Becoming a New Provider?

We’re always looking for exceptional providers to join our growing network of physicians and hospitals. Together, we can help you give your patients—and our members—the quality, cost-efficient care they deserve. Click here to learn more.
 

Contact Your FirstCare Provider Relations Team

Our Provider Relations Team is here for you. If you have questions or need support, please click here to find contact information.


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

Frequently Asked Questions about the Medicaid Standing Order for Mosquito Repellent

For additional information click here.

RSV Season Extended for Counties in Southeast Texas and Gulf Coast Areas

For additional information, click here.

View all provider news >

We're here to help.

Our Provider Relations Team is here for you. If you have questions, please click here to find contact information.


The National Committee for Quality Assurance (NCQA) awarded FirstCare Health Plans an Accredited Status (Commercial, Medicaid and Marketplace HMO, recertified 02/2018)—reflecting our continuous work to fulfill NCQA requirements for consumer protection & quality improvement.

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