SHA, LLC (FirstCare) Prior Authorization

SHA, LLC (FirstCare) prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

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

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Provider portal

• Fax

• Phone (preauthorization department)

• Submission resource 1

• Submission resource 2

• Submission resource 3

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