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.
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.
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.

Providers

Effective Jan. 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 hereto find contact information.


Quality Improvement Subcommittee (QIS)

The Quality Improvement Subcommittee (QIS) develops, reviews and approves clinical programs and guidelines, studies, and other clinical activities related to the health care services provided to FirstCare members.


Prior Authorization

Prior authorization is sometimes called pre-certification or pre-notification. Prior authorization verifies whether medical treatment that is not an emergency is medically necessary. It also determines if the treatment matches the diagnosis and that the requested services will be provided in an appropriate setting. During prior authorization, Baylor will also verify if the Member has benefits.



Provider News

Revised VDP Manuals Available

Read more here

Summary of Jan. 2024 Drug Utilization Review Board Meeting Now Available

Read more here.

View all provider news >



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

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