MedicaidCoverageHigh impact
Update: MCO Providers Have 95 Days to Submit Claims With a DOS On or Before August 31, 2026, for Baylor Scott & White and FirstCare Health Plans
Texas Medicaid·TX·General
Effective date
Sep 1, 2026
We identified it
Sep 3, 2026
Summary
Effective September 1, 2026, Baylor Scott & White and FirstCare health plans will no longer participate in Texas Medicaid managed care. Providers have 95 days from the effective date to submit all claims with a date of service on or before August 31, 2026. Any claims with a DOS on or after September 1, 2026, will be rejected by TMHP.
Action Required
By November 4, 2026 (95 days from September 1, 2026): Billing team must submit all outstanding claims for Baylor Scott & White and FirstCare Health Plans patients with a date of service on or before August 31, 2026, to TMHP. After this deadline, any claims with DOS on or before August 31, 2026, will not be accepted. Beginning September 1, 2026, the billing team must redirect all Baylor Scott & White and FirstCare Health Plans beneficiaries to alternative Medicaid managed care plans or Traditional Medicaid coverage. Update billing system to flag and route claims for these plans appropriately. Contact TMHP Contact Center at 800-925-9126 for guidance on claim disposition. Failure to submit claims within the 95-day window will result in permanent claim denial.