Resources
Talk to a Nurse—Nurse24™
Need care advice? Should you see a doctor? FirstCare members can talk to a nurse by calling 1-855-828-1013. Get answers 24/7! Information is available in English and Spanish. Interpreter services available upon request. TTY users can call 711 or 1-800-955-8771. Voice communication is available at 1-800-955-8770.
Healthy Texas Women Plus
Texas HHSC implemented Healthy Texas Women (HTW) Plus, an enhanced, cost-effective and limited postpartum services package for women in the HTW program. HTW Plus will be provided for no more than 12 months after the start date. Women in HTW Plus will have access to HTW and HTW Plus benefits.
healthytexaswomen.org
Utilization Management
Ever wonder how we decide to authorize services? Our decisions are based on medical evidence and consensus of health care professionals.
Utilization Management Decisions
State Fair Hearing
Members who disagree with the health plan's decision have the right to ask for a fair hearing only after exhausting the MCO Internal Appeal System provided by FirstCare. Ask for a State Fair Hearing by contacting us toll-free at 1-800-431-7798 / TTY 711. Our Member Services can help you file a fair hearing.
External Medical Review
Members sho disagree with the health plan's decision have the right to ask for a State Fair Hearing (standard or expedited) only after exhausting our Internal Appeals process or you can ask for a State Fair Hearing with an External Medical Review (EMR) (standard or expedited). You cannot only ask for an External Medical Review. An EMR is an optional, extra step for the member to have a case outside the Hearing, free of charge. To request an EMR, call us at 1-800-431-7798 / TTY 711.
Non-Emergency Medical Transportation (NEMT)
1-833-779-3105
For more details, visit:
access2care.net/texas View more information
Prescription Benefits Manager
1-855-897-4448
Navitus Health Solutions