STAR & CHIP Providers
Texas Health and Human Services - COVID-19 Information
Provider Portal
FirstCare providers have access to our online self-service portal. Here, you can look up claims, request an authorization, appeal a claim, and much more.
Log in/register to the Provider Portal.
Becoming a New Provider
Interested in joining our network? Please visit the
Becoming a New Provider page for general information. The following pertains specifically to our STAR & CHIP providers:
Credentialing Forms
Click on the links below to view/download FirstCare's Provider Credentialing forms:
Expedited Credentialing
The expedited credentialing process allows providers to participate in the FirstCare network on a provisional basis. This provisional status is available if:
- Provider is a first time applicant to FirstCare and provisional credentialing request is based on a critical need of the members.
- Provider is joining as a partner, shareholder or employee of a currently contracted and credentialed FirstCare provider in good standing.
- Provider has submitted the appropriate paperwork, including a complete Texas Standard Credentialing Application with current attestation.
- The applicable Regional Medical Director has reviewed the request and determined the application cannot be completed in 30 days or less.
- The required verifications must indicate the file is clean. This includes a state license in good standing with the appropriate medical board, as well as a clean NPDB query.
All provisionally approved providers must agree to comply with the terms of the FirstCare contract currently in force with the applicant physician’s established medical group. The full credentialing process must be completed within 60 calendar days of the date a physician is granted provisional status.
Provider Availability of Services
FirstCare monitors compliance for availability of services standards. In order to ensure the best quality of care for our members, we ask participating providers to operate within the standards described in the
Minimum Requirements for Provider Availability of Services.
STAR & CHIP Provider Training
Cultural Competency
An effective health communication is as important to health care as clinical skill. To improve individual health and build healthy communities, health care providers need to recognize and address the unique culture, language and health literacy of diverse consumers and communities.
Additional cultural competency resources can be found on the
U.S. Department of Health and Human Services Office of Minority Health website.
Pharmacy Information
Formulary
- FirstCare is state mandated to adhere to the Texas Medicaid formulary and Preferred Drug List, which are developed and maintained by the Texas Drug Utilization Review (DUR) Board and Texas HHSC Vendor Drug Program (VDP). Additional information regarding VDP including formularies, preferred drug list, and Texas DUR Board meeting minutes and updates can be found on the Texas Vendor Drug Program webpage.
- The Texas Medicaid formulary and Preferred Drug List are available on the Epocrates drug information system. The service is free and provides instant access to information about the Texas Medicaid formulary through the internet or a handheld device.
- The Texas STAR Formulary is available in paper form without charge. To request a copy, please call FirstCare STAR Customer Service at 1-800-431-7798.
Prior Authorizations
- FirstCare administers the prior authorization criteria approved by the Texas DUR Board. For a listing of clinical edits implemented by FirstCare please click here, and for access to FirstCare's prior authorization forms please click here.
- To obtain pharmacy prior authorization assistance for Medicaid CHIP, please call FirstCare Medicaid CHIP PBM, Navitus, Toll Free at 1-877-908-6023 and select the prescriber option to speak with the Prior Authorization department between 6 a.m. to 6 p.m. weekdays and 8 a.m. to noon weekends Central Time (CT), excluding state approved holidays.
- Download the State of Texas Standard Prior Authorization Form
- CHIP Pharmacy Prior Authorization Timeline
- For routine PA requests within three Business Days after receipt
- For urgent PA request within 1 Business Day
- STAR Pharmacy Prior Authorization Timelines
- If the prescriber's office calls the MCO's PA call center, the MCO must provide prior authorization approval or denial immediately.
- For all other PA requests, the MCO must notify the prescriber's office of a PA denial or approval no later than 24 hours after receipt.
- If the MCO cannot provide a response to the PA request within 24 hours after receipt or the prescriber is not available to make a PA request because it is after the prescriber's office hours and the dispensing pharmacist determines it is an emergency situation, the MCO must allow the pharmacy to dispense a 72-hour supply of the drug.
A 72-hour emergency supply of a prescribed drug may be provided when a medication is needed without delay and prior authorization (PA) is not available. This applies to all drugs requiring a prior authorization (PA), either because they are non-preferred drugs on the Preferred Drug List or because they are subject to clinical edits.
The 72-hour emergency supply may be dispensed when a PA cannot be resolved within 24 hours for a medication on the Vendor Drug Program formulary that is appropriate for the member's medical condition. If the prescribing provider cannot be reached or is unable to request a PA, the pharmacy should submit an emergency 72-hour prescription. The emergency supply is subject to pharmacist clinical judgement. Some non-urgent medications are exempt from this emergency supply.
A pharmacy can dispense a product that is packaged in a dosage form that is fixed and unbreakable, e.g., an albuterol inhaler, as a 72-hour emergency supply.
To be reimbursed for a 72-hour emergency prescription supply, pharmacies should submit the following information:
Claim Submission Process:
Place '8' in "Prior Authorization Type Code" (Field 461-EU), '801' in "Prior Authorization Number Submitted" (Field 462-EV) and '3' in "Days' Supply" in the claim segment of the billing transaction (Field 405-D5). The quantity submitted in "Quantity Dispensed" (Field 442-E7) should not exceed the quantity necessary for a three-day supply. It is permissible that a pharmacy dispense product packages in fixed dosage forms (e.g., inhalers, nebulized medications) that are unbreakable as a 72-hour supply. Place '3' in "Days' Supply" but enter the full quantity dispensed.
Pharmacy Provider Manual
- To obtain a copy of the Pharmacy Provider Manual, please visit www.navitus.com.
- For Pharmacy questions contact FirstCare Customer Service at 1-800-431-7798.
Pharmacy Maximum Allowable Cost (MAC) List
- To obtain a copy of the MAC List, network pharmacies may visit the Navitus pharmacies website and go to the MAC Program link: pharmacies.navitus.com
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Complaints & Appeals
Filing complaints & appeals to FirstCare STAR
- Call: 1-800-431-7798,
- Fax: 1-877-878-8422,
- Email: cs-informationcenter@bswhealth.org, or
- Mail to: FirstCare Health Plans
Attn: Complaints and Appeals Department
1206 W Campus Drive
Temple, TX 76502
Filing complaints & appeals to FirstCare CHIP
- Call: 1-877-639-2447,
- Fax: 1-877-878-8422,
- Email: cs-informationcenter@bswhealth.org, or
- Mail to: FirstCare Health Plans
Attn: Complaints and Appeals Department
11206 W Campus Drive
Temple, TX 76502
Filing complaints to HHSC
- Email: HPM_Complaints@hhsc.state.tx.us, or
- Mail to: Texas Health and Human Services Commission
Health Plan Operations – Resolution Services H-320
P.O. Box 85200
Austin, TX 78708
Filing complaints to TDI
- Call: 1-800-252-3439, OR
- Mail to: Texas Department of Insurance
P.O. Box 149104
Austin, TX 78714-9104