SHA, LLC (FirstCare)
SHA, LLC (FirstCare) Prior Authorization
Prior authorization is required for certain services; FirstCare’s provider guidance says requests can be submitted through the provider portal or by fax, and…
Short answer
Prior authorization is required for certain services; FirstCare’s provider guidance says requests can be submitted through the provider portal or by fax, and the provider manual notes phone contact for preauthorization. For STAR/CHIP, the provider manual…
SHA, LLC (FirstCare) publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.
At a glance
- Prior authorization is required for certain services; FirstCare’s provider guidance says requests can be submitted through the provider portal or by fax, and the provider manual notes phone contact for preauthorization. For STAR/CHIP, the provider manual states authorization requests are accepted from in-network and out-of-network providers. For commercial HMO/PPO, the portal is also used to view authorization status and requirements. Approval is not a guarantee of coverage.
- Services remain subject to benefits, exclusions, eligibility, and network rules even when authorized.
- Failure to obtain required prior authorization may lead to denial and providers may not bill members for denied services in the cited STAR/CHIP manual sections.
- Specific prior-authorization requirements vary by product/service; use the service-code lookup in the provider portal.
Where to verify prior authorization requirements
How to submit prior authorization requests
-
Provider portal
-
Fax
-
Phone (preauthorization department)
Information commonly required
- Clinical information supporting medical necessity
- Diagnosis and treatment plan
- Supporting test results or other pertinent clinical data
- For elective/non-emergent admissions, request at least 2 working days before planned service/admission
- For STAR/CHIP, clinicians may need to provide information sufficient to verify service, setting, and appropriateness
Turnaround notes and caveats
- STAR/CHIP provider manual: clinical criteria are provided within 10 days of request
- STAR/CHIP provider manual: some prior-auth determinations are reviewed through utilization review pathways; urgent/post-stabilization reconsiderations may be handled 24/7
- Commercial HMO/PPO manual notes prior-auth notice changes are communicated to providers, but does not state a standard decision turnaround in the cited sections
- Services remain subject to benefits, exclusions, eligibility, and network rules even when authorized.
- Failure to obtain required prior authorization may lead to denial and providers may not bill members for denied services in the cited STAR/CHIP manual sections.
- Specific prior-authorization requirements vary by product/service; use the service-code lookup in the provider portal.
Provider resources
- FirstCare Provider information hub (official)
- STAR & CHIP Provider Information (official)
- Provider Authorization Information (official)
- 24/7 Self-Service Portal (official)
- Commercial HMO/PPO Provider Manual (PDF) (official)
- 2025 STAR and CHIP Provider Manual (PDF) (official)
- Medicaid corrected claims/redeterminations instructions (PDF) (official)
- Provider Portal registration (official)
Sources
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Provider portal used to submit new authorization requests and view requirements | FirstCare in-network providers are encouraged to access the service code search tool via the Provider Self-Service portal to submit new authorization requests, view authorization status and view prior authorization requirements. | Official | high |
| Authorization submission methods | Registered users may log in and submit a prior authorization request electronically via the secure provider portal; alternatively, complete and fax the prior authorization request form; phone contact is also listed. | Official | high |
| Clinical criteria availability | Clinical criteria are available upon request and are provided to all providers within 10 days of request. | Official | high |
| Elective lead time | For non-emergent elective admissions and procedures, contact FirstCare at least 2 working days before the planned service or admission. | Official | high |
| Coverage caveat | Provision of preauthorization for a specific service is not a guarantee of payment; payment is subject to covered benefit and plan conditions. | Official | high |
Last reviewed: March 27, 2026
Sources used: 2 official
Automating prior authorization work
Clark Street Health is testing early-access workflows for requirements checks, status follow-up, document routing, and staff exceptions. Payer rules and clinical decisions still need the controls defined by your practice.
Review the prior authorization workflow