Welcome to this special edition of the Provider Insider: a monthly newsletter for Trillium providers. We will be highlighting Tailored Plan, which launches July 1, 2024. Find all the information you need here as a provider to be successful on day one. Throughout the newsletter, links are underlined. Click on these underlined links to direct you to resources, documents, and other helpful tips that can be used to support our members. | |
Inside this Tailored Plan edition | |
- North Carolina Department of Health and Human Services (NCDHHS) Tailored Plan Resources
- Provider Resources
- Trillium Tailored Plan Resources
- About Trillium Tailored Plan Partners
- North Carolina Department of Health and Human Services (NCDHHS) Bilingual Transition to Tailored Plans Toolkit
- Welcome New Providers!
| |
Trillium Tailored Plan Launches July 1, 2024 | |
|
Trillium Health Resources begins operating the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan on July 1, 2024. The Trillium Tailored Plan will manage behavioral and physical health services for individuals on NC Medicaid and with the following:
- Serious mental illness (SMI)
- Severe substance use disorders (SUD)
- Intellectual/developmental disabilities (I/DD)
- Traumatic brain injuries (TBI)
- NC Innovations Waiver members, and those on the waitlist
“Trillium has been making the necessary preparations to launch the Trillium Tailored Plan for years,” stated Joy Futrell, CEO of Trillium. “We are more than ready to implement all the new processes, requirements, and reports starting July 1. However, our most important goal remains the same: For every community and individual we serve to reach their fullest potential.”
News Release
| |
North Carolina Department of Health and Human Services (NCDHHS) Tailored Plan Resources | |
NCDHHS Tailored Plan Fact Sheets | |
NCDHHS has provided several Fact Sheets about Tailored Plan launch for providers to reference. These Fact Sheets provide helpful information, checklists, reminders, and more for providers after transition to Tailored Plan.
| |
Flexibilities to Ease Provider Administrative Burden at Tailored Plan Launch | |
|
NC Medicaid is committed to ensuring our providers and members are supported at the launch of the Behavioral Health Intellectual/Developmental Disabilities (I/DDs) Tailored Plans, which will launch on July 1, 2024. A key priority at transition is to ensure NC Medicaid beneficiaries receive the care they need as scheduled, with no interruption, after launch on July 1, 2024.
The Department has implemented policy flexibilities to ease provider administrative burden at launch and ensure beneficiaries receive uninterrupted care.
Read More Here
| |
NC Medicaid Managed Care Provider Playbook | |
|
Access the latest information, tools and other resources to help you and your patients smoothly transition to NC Medicaid Managed Care. Visit the Provider Playbook here often, as resources will be added as they become available. Fact sheets, trending topics, frequently asked questions (FAQs), trainings, and more are available in the Provider Playbook for your review.
| |
Access to All Provider Portals and Manuals | |
|
Find all the Portals and Manuals you need as a provider conveniently in one location. Located on Trillium's website, access:
- Behavioral Health I/DD Provider Portal (Provider Direct)
- Physical Health Provider Portal
- Pharmacy Portal (PerformRx)
- Complex Imaging Portal
- Behavioral Health I/DD Tailored Plan Provider Manual
- Physical Health Provider Manual
Provider Portals and Manuals
| |
Benefit Plans and Service Definitions | |
|
Locate the information you need regarding the following on our website:
- Benefit Plan Information
- Prior Authorization Services - Behavioral Health Services/Physical Health Services
- Service Definitions
- In Lieu of Services and Alternative Services
- Tailored Plan Medicaid Member Pharmacy Benefits
- Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
Benefit Plans and Service Definitions
| |
Trillium Tailored Plan Resources for Providers | |
Trillium Health Resources has Tailored Plan resources and helpful information for providers available on our website. Access guides, trainings, and other essential Tailored Plan documents from Trillium below by clicking on the underlined links. Trillium remains committed to supporting providers as they serve our members during the transition to Tailored Plan. | |
Trillium Tailored Plan Quick Reference Guide | |
|
Providers should review Trillium's Tailored Plan Quick Reference Guide for important phone numbers, website links, and descriptions. Use this guide when information is needed quickly.
| |
Trillium Tailored Plan Provider Training Sessions | |
|
Trillium hosted opportunities during the month of June for providers to attend Tailored Plan Training Sessions on June 6, June 11, June 20, and June 26, 2024. During these sessions, providers were encouraged to ask questions and relay any concerns about Tailored Plan to Trillium Subject Matter Experts (SME). Leaders from various departments within Trillium such as Claims, Utilization Management, and Care Management were available to provide feedback and guidance during the sessions.
Tailored Plan Provider Training Sessions focused on the following topics:
- Claims
- Network Management
- Utilization Management
- Tailored Care Management
Please visit Trillium's Tailored Plan Training page to review the recording from each Provider Training Session.
Additional Training opportunities can be accessed by providers on My Learning Campus.
| |
Trillium Provider Communications | |
|
Stay in the know with Trillium by signing up for Provider Communications here. Trillium Provider Communications ensure our providers are updated with critical information needed to best serve our members as soon as possible.
Previous Provider Communications are available on our website for provider reference:
| Contracting with Trillium | |
|
Trillium partners with practitioners and provider agencies to build community well-being through the delivery of person-centered services and supports. This is accomplished by Trillium and the provider entering into a contractual agreement for the provision of services.
Visit the Contracts page on Trillium's website to learn more about Provider Recruitment Opportunities, contracting information, and where to direct questions related to Contracts.
| |
Trillium Contact Information | |
|
Trillium Health Resources offers various avenues for members/recipients and providers to contact us. Our team has dedicated staff available to answer your questions and concerns. Please see below contact information for providers:
- Provider Support Service Line (PSSL) - call our PSSL team at 1-855-250-1539 Monday-Saturday 7:00AM-6:00PM with questions or needs. Trillium agents will direct you to the correct department for support.
-
Member and Recipient Services Line - Members and Recipients can connect with a Member Services agent by calling 1-877-685-2415 Monday-Saturday 7:00AM-6:00PM with questions, to schedule non-emergency medical transportation (NEMT), and need for services.
- Behavioral Health Crisis Line - members can call 1-888-302-0738 24 hours a day, 7 days per week if experiencing a behavioral health crisis.
-
Provider Support - your questions and inquiries will be routed to the appropriate Trillium department when you email our Network Services Ticket System at NetworkServicesSupport@TrilliumNC.org.
-
Provider Portal/IT Assistance - send an email to our IT team when you need assistance with Provider Direct, logins, passwords, access to platforms, and other needs at PDSupport@TrilliumNC.org.
-
Claims Support - reach out to our Claims team with questions and claims-related concerns by emailing ClaimsSupport@TrilliumNC.org.
-
Secure Email - available for providers to create and send secure emails to Trillium staff.
| |
Trillium Behavioral Health/IDD Tailored Plan/PIHP Provider Manual | |
|
Trillium's Provider Manual includes important information including the following:
- How to file claims
- Member Rights, including filing appeals and grievances
- Provider Responsibilities
This Manual includes the processes and procedures Trillium expects from our providers, and tells providers what to expect from Trillium. Find Trillium's Provider Manual here.
| |
Trillium Provider Directory | |
|
Locate Trillium contracted providers easily by visiting our Provider Directory. Our Directory is updated daily to ensure the information reflected is as accurate as possible.
Search for Trillium providers by using filters such as specialties, disciplines, and more. Click here to access Trillium's Provider Directory.
If you need additional assistance locating a provider or can't find what you are looking for, please call our Member and Recipient Services Line at 1-877-685-2415.
| |
Information on Authorizations and No Prior Authorizations for Providers | |
|
For Medicaid services, there will be a No Prior Authorization (NPA) required period for 91 days effective 7/1/24. This No Prior Authorization period will extend through 9/30/24. Prior authorization approval will be required effective 10/1/24. Providers may begin submitting Treatment Authorization Requests (TARs)beginning September1for services beginning 10/1/24. You may submit up to 30 days prior to the start date of service, so any submission dates during the month of September are permissible.
Although we are under an NPA required period through 9/30/24, some providers are electing to submit a TAR with required clinical documentation for prior authorization. These TARs will be reviewed and processed.
The No Prior Authorization (NPA) period for State Funded benefits will end 6/30/24. This does not apply to services that have an unmanaged benefit or NPA “pass through.” Please refer to the authorization guidelines on the MH/SU and IDD Trillium benefit plans found on the Trillium website to determine which services will require prior authorization. Please begin submitting TARs now to ensure authorizations are in place for claims for dates of services beginning July 1, 2024.
For further guidance on State-funded benefits, please review Clinical Communication Bulletin 55 and Clinical Communication Bulletin 57.
Pharmacy Prior Authorizations:
Prior Authorization (PA) forms are available on the Trillium Health Resources Provider website.
For the first 90 days (7/1/2024 – 9/30/2024) PAs for historical claims will be relaxed.
In the event that a historical prior authorization was not received from NCDHHS, but can be verified through the NCTracks system, Trillium will honor that authorization through the original end date.
If a new PA is needed, if must be initiated with PerformRx and does not fall under the flexibilities allowed for the TP launch.
Providers can review Trillium's Pharmacy Prior Authorization webpage here.
For additional guidance on Authorizations, please access Trillium's Tailored Plan Provider Training Sessions.
| |
Behavioral Health I/DD Provider Portal (Provider Direct) | |
|
A secure platform for mental health, I/DD, and substance use providers to access for the following:
- Enter or upload Treatment Authorization Requests (TARs) to obtain prior authorization
- Upload Person-Centered Plans and Individual Service Plans (ISPs)
- Access and file claims
- Submit complaints/grievances
- Access the Provider Manual
Please see the instructions on how to access Provider Direct. All providers must complete the required training and paperwork to access Provider Direct. Access Provider Direct here.
| |
Trillium Tailored Plan Partnerships | |
|
Carolina Complete Health (CCH) is Trillium Health Resources' Standard Plan Partner for Tailored Plan.
CCH will be responsible for Trillium's Physical Health Network including Primary Care, Specialty Care, Durable Medical Equipment (DME), Vision, Long-Term Services and Supports (LTSS) Non-Emergency Medical Transportation (NEMT), and Non-Emergency Ambulance Transportation (NEAT).
Navigate CCH's website here for more information.
| |
Trillium Physical Health Portal Set Up
To access the Trillium Physical Health Portal, contracted providers must first identify an individual who will serve as their Portal Account Manager.
Provider Portals and Manuals
| |
|
Modivcare is contracted with Trillium Health Resources to arrange non-emergency medical transportation (NEMT) for members. The allowable benefits may vary by treatment type and may include:
- Public transportation (vans or buses)
- Ambulances (air and ground, including non-emergency)
- Wheelchair lift-equipped vehicles
- Taxis
Members, their family members/relatives, or providers are able to call Modivcare to request and schedule their transportation. Member Reservations and the Ride Assist Help Line is available at 1-877-685-2415, Monday-Saturday from 7:00AM-6:00PM.
For more information about Modivcare, please view their brochure and their website.
| |
Centene Vision Services (formerly Envolve) | |
|
Trillium Health Resources' Vision Partner is Centene Vision, a subsidiary of Carolina Complete Health. Centene Vision is responsible for Trillium's Optometry Network.
Providers can access the Envolve Vision Provider Web Portal here and utilize Eye Health Manager, available 24/7 to verify member eligibility and benefits, file claims and review claim status, use audit tools, and download, research, and reprint EOPs.
To learn more about Centene Vision Services, please visit their website or reference the CCH Provider Manual.
| |
|
Trillium has partnered with PerformRx, to oversee the pharmacy benefit plan. They work to provide access to medications prescribed by psychiatric and physical health prescribers. Medications can help members improve their quality of life, experience better success in recovery, and provide positive outcomes.
Trillium covers medications on the drug formulary established by NCDHHS. A drug formulary is the list of generic (such as acetaminophen instead of Tylenol®) and brand-name prescription drugs covered by the Tailored Plans. In most cases, a generic drug will be required to be dispensed, but the plan covers all brand medications if a generic substitution is not available. Medications are classified on the Preferred Drug List (PDL) as Preferred, Non-Preferred, or Non-PDL.
Please visit Trillium's Tailored Plan Medicaid Providers Pharmacy Benefits page for a searchable formulary, pharmacy locator, and more information.
| |
NCDHHS Bilingual Transition to Tailored Plans Toolkit for Providers | |
|
Providers can access free materials to promote and explain Tailored Plans with helpful flyers, graphics, and more. Utilize these resources here.
| |
| PROVIDER NAME | COUNTIES SERVED | SERVICES OFFERED | AGE GROUP SERVED | | Amara Wellness Services Inc. | Mecklenburg | Outpatient Therapy, Evaluation & Management, Community Support Team, and Psychosocial Rehabilitation; 1915i: Crisis Intervention, Home and Community Supports, Respite, Residential Supports, Supported Employment, Natural Supports Education, and Supported Living | Adult | | Carolina Solution Inc. | Hoke & Scotland | Outpatient Therapy, Evaluation & Management, Community Support Team, Peer Supports, Intensive In-Home, and Psychosocial Rehabilitation; State: Community Support Team | All | | Creative Psychological Services | Pitt | Psychological Testing and Outpatient Therapy | All | | Crystal J. Martinez DBA Odin Healthcare PLLC | Columbus & Gaston | Office-Based Opioid Treatment, Outpatient Therapy, and Evaluation & Management | All | | Highlights Psychological Associates | Iredell | Psychological Testing | Children & Adolescents | | Modern Hope of North Carolina | Davidson | Research Based Behavioral Health Treatment | All | | Radson and Strayer Psychological Services PLLC | Nash | Psychological Testing | All | | That Advocate Lady | Guilford | 1915i: Community Navigator & Natural Supports Education | Adults | | Virginia's Group Home LLC | Cumberland & Sampson | Residential Treatment Level III | Children & Adolescents | | Worry Free Psychology | Wake | Psychological Testing | All | | |
|
Trillium to launch Healthy Opportunities Pilot Program
Trillium Health Resources launched the Healthy Opportunities Pilot program in 15 of our counties on May 15, 2024. The pilot will cover a select set of non-medical, evidence-based services for high-risk health plan members. Services address housing, interpersonal safety, food, and transportation to improve the health and well-being of members.
| |  |
|
Re-verification Requirement
You should have received a Re-verification Notification from NCTracks. If you have not responded, please act now. If you do not submit the re-verification application and pay the application fee by the due date, your Medicaid claims will not be paid.
| |
|
Have Questions/Need Support?
If you have questions, need additional information, or require technical assistance, please contact our Network Management Department at NetworkServicesSupport@TrilliumNC.org or call Provider Support Services at 1-855-250-1539 during the hours of 7 a.m.–6 p.m. EST, Monday–Saturday.
We appreciate your commitment to helping us achieve this mission by meeting the needs of members!
| |
Provider Insider is a newsletter for the Trillium Health Resources provider community. Please send comments and suggestions about this publication and its contents to NetworkServicesSupport@TrilliumNC.org. | | | | |
