Trillium nc medicaid. Apr 3, 2024 · It’s official! Tailored Plans will launch on Ju...

Trillium nc medicaid. Apr 3, 2024 · It’s official! Tailored Plans will launch on July 1, 2024. Trillium utilizes the Provider Enrollment File and/or the NC Tracks Operations Portal to validate enrollment and credentialing. PA is required for Wegovy coverage. Jul 1, 2024 · Trillium Health says it will be available across the 46 counties it serves. , Medicaid – Carolina Complete Health, Inc. Nov 7, 2018 · Trillium. The Account Manager Jan 8, 2024 · A state-approved merger will allow Trillium Health Resources to manage mental health care, substance misuse treatment and disability services for many low-income residents in 46 North Carolina counties. The name is changing, but the services are not. How to find your local Department of Social Services: Use this directory or call the NC Medicaid Contact Center at 1-888-245-0179. They cover your mental health, severe substance use, I/DD, TBI and prescriptions in one plan. You may be eligible for Tailored Care Management if your health plan is with Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health. gov Trillium embraces North Carolina's Crisis Solutions Initiative to ensure people know where to get help quickly and effectively. A “copay” is a fee you pay when you get certain health care services from a provider or pick up a At Trillium Health Resources, we help people find and get the care and services they need. Call 1-919-881-2320. Refer to the Prior Approval Criteria for specific drug criteria. Feb 19, 2026 · Apply over the phone Call your local Department of Social Services (DSS) to apply over the phone. Jun 18, 2024 · Who is eligible for tailored plans? North Carolinians who are enrolled in Medicaid and have long-term care needs stemming from an intellectual or developmental disability, severe substance use disorder, serious mental illness or traumatic brain injury How are tailored plans different from standard Medicaid plans? Mar 9, 2026 · Information about Trillium Health plan 1915 (i) services and processes for North Carolina Medicaid Tailored Care Management (TCM) and 1915 (i) service providers. 1, 2023, your income can be higher, and more adults aged 19 through 64 years will be eligible. org; or Mail the appeal, hardcopy, to: Attn: NEW! If your NC Medicaid is moving to a Tailored Plan, call your Tailored Plan to request these ride services: Alliance Health: 1-855-759-9600 • Trillium Health: 1-877-685-2415 Partners Health: 1-855-397-3611 • Vaya Total Care: 1-800-962-9003 You can begin scheduling rides today for appointments on or after July 1, 2024. Copays A copay is a fee you pay when you get certain health care services or prescriptions. While NC Medicaid encourages establishing care with a medical home, coverage without a prescription allows Medicaid beneficiaries easy access to the product and reduces barriers such as having to make an appointment to get a prescription, needing transportation to the appointment, or even a lack of health care providers in the community. Soon after, members should have received welcome packets from Trillium. Nov 20, 2025 · You may be eligible for Tailored Care Management if you have NC Medicaid with Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health. Consistent with federal requirements and NC Medicaid’s vision to ensure continuity of care for members transitioning between prepaid health plans (PHPs) or service delivery systems, NC Medicaid has released the NCDHHS Transition of Care Policy. The North Carolina Innovations Waiver Services (NC Innovations) is a resource for funding services and supports for a Medicaid member with intellectual and other related developmental disabilities who are at risk for institutional care in an Intermediate Care Facility for Individuals with Intellectual Disabilities (Please refer to Clinical Trillium Health Resources (Trillium) Billing Guide will provide information to support your claim processes. Trillium can arrange and pay for your transportation to help you get to and from your appointments for Medicaid-covered care. Trillium has a waitlist for those state-funded recipients who are waiting to receive Care or Case Management. If you are seeing a Tailored Plan member in need of these services, please complete the following information for questions related to NC State Plan Personal Care Services. 55 million, with around 76,900 individuals on Medicaid in our region who are potentially eligible for the Tailored Plan. A Primary Care Provider can still s and Trillium. North Carolina Labcorp will file claims for insured patients directly to Medicare, Medicaid and many insurance companies and managed care plans. Carolina Complete Health (CCH) will support physical health claims Prior authorization is not required for MCD BH Services rendered to Medicare/Medicaid dual eligible members or members with 3rd-party insurance because MCD is the payer of last resort. The healthcare organization says benefits include new benefits for physical and pharmacy services, non-emergency medical Feb 6, 2026 · Pharmacy Prior Authorization Prior approval (PA) is required for certain drugs prescribed to NC Medicaid Tailored Plan recipients. At a legislative committee on April 2, 2024, NC Medicaid shared that the Local Management Entities (LMEs) that will run Tailored Plans – Alliance Health, Partners Health Management, Trillium Health Resources and Vaya Health – are all ready to go live. pdf PDF • 185. This change is intended to help you quickly identify standardized services rates and reflects Trillium's ongoing efforts to work towards rate alignment across the organization. Please review the Member and Recipient Handbooks for more information. The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding primary health providers (PHPs). Our teams take time to listen, answer questions, and help individuals and families understand their options. We partner with a group of health care providers (doctors, therapists, specialists, hospitals and other health care facilities) that make up our provider network. You will get a new Medicaid ID card in February; until then, you can continue using your existing card. Trillium recommends provider agencies conduct periodic Self-Audits to identify instances where services reimbursed by Medicaid are not in compliance with program requirements. Someone may be reaching out to you to answer a satisfaction survey about the health services you get from AmeriHealth Caritas North Carolina. Trillium NC SNAP Training Eligibility and Registration Forms Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years Old Regional Referral Form for Admission to a State Psychiatric Hospital or ADATC Worksheet for Requesting Exceptions to the Diversion Law (SB 859) NC Medicaid provides benefits or health care services covered by your plan. Services covered and listed below will be either for members, recipients, or both as noted. The NC Innovations Waiver (1915c Medicaid Home and Community-Based Services) Non-medical services such as supported Members with NC Medicaid Direct and State-funded Recipients are not eligible for Value-Added Services. Medicaid Rebase Rate Reductions The North Carolina Division of Health Benefits (DHB) provided official notification to Trillium Health Resources regarding changes to NC Medicaid fee schedule rates effective October 1, 2025. If the patient is enrolled in a Trillium Tailored Plan, the service will be billed to Carolina Complete Health. pdf PDF • 1. Trillium is responsible for providing access to and oversight of services for individuals who receive Medicaid or state funding for their care. You do not have to pay any monthly premiums. Dec 3, 2025 · NC Medicaid Copays Versión en español NC Medicaid is low or no-cost to you. Jun 21, 2024 · What is a Tailored Plan? Tailored Plans are a new kind of NC Medicaid Managed Care health plan. Some members may be required to pay a copay. Some beneficiaries will remain in NC Medicaid Direct (excluded) or can choose NC Medicaid Di ect instead of a health plan (exempt). Appeals & Grievances Medicaid members and state-funded recipients have the right to tell us if something is wrong. senate. Botox injections for spasticity is a physical health procedure. Trillium Physical Health Portal Setup: To access the Trillium Physical Health Portal, contracted providers must identify an individual who will serve as the Portal Account Manager. We also have innovative new programs that embrace whole-person care. If you need to update your contact information, click the link below. The consolidation prioritizes doing what is best for members and providers, focuses on whole-person care, and promotes continued investment in the communities we serve. Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with serious behavioral health, intellectual/developmental disabilities, and traumatic brain injury in North Carolina. Tailored Plan Billing with Partners and Trillium for Physical Health Providers Upon the launch of Tailored Plans on 07/01/24 many North Carolina Medicaid Direct members will transition into a Tailored Plan. If the patient is enrolled in Medicaid Direct, the service will be billed to NC Medicaid. Your answers can help make sure you get the best care and service from us. Services are available for Medicaid members and state-funded recipients. Download free Adobe Acrobat Reader HERE Trillium Health Resources also coordinates Personal Care Services for Medicaid members placed on the Tailored Plan. Versión en español Video in American Sign Language (ASL) On December 1, 2023, NC Medicaid expanded to cover people ages 19 through 64 up to 138% of the federal poverty line. Providers can continue using NCTracks to verify member eligibility and determine the Tailored Plan they are assigned. Member Benefit Plans Trillium coordinates services for Medicaid members in the Trillium Tailored Plan or NC Medicaid Direct, and state-funded recipients. Also, ease note if there is another coverage, Me The NC Innovations Waiver is a federally funded Medicaid program Part of the federal requirement is to maintain documentation of services accessed Trillium is required to assure NC Innovations funds are used appropriately and in a way that meets federal and state requirements For example, NC Innovations Waiver services cannot be used to provide North Carolina Department of Health and Human Services (DHHS) Tailored Care Management Technical Advisory Group (TAG) Meeting #30 (Conducted Virtually) May 21, 2024 WEIGHT MANAGEMENT AGENTS Off-Cycle Update: Added Wegovy® (semaglutide) Pen as Preferred [covered only for the cardiovascular risk reduction indication]. This service is for people with NC Medicaid to help them get to their medical and mental health appointments. For dates of service beginning 7/1/24, instead of submitting physical health claims to Medicaid Direct for Trillium Tailored Plan members, providers should submit using the methods outlined in the Trillium Claims Provider Training. The Trillium Provider Directory lists the languages that providers have identified that one or more of their staff members speak. You can search for more than one filter, like “Health Plan” and “Specialties” under the Specialties list. . 08 MB - November 07, 2018 Contact Information NC Department of Health and Human Services 2001 Mail Service Center Raleigh, NC 27699-2000 Customer Service Center: 1-800-662-7030 Trillium also serves Medicaid members in NC Medicaid Direct. nc. Find a HealthCare Provider Skip to main content Jun 3, 2018 · NC Medicaid Provider Ombudsman: 1-866-304-7062 and Medicaid. Trillium Community Health Plan (Trillium) requires prior authorization (PA) as a condition of payment for many services. AmeriHealth Caritas North Carolina would like to know what you think. Learn more about how we improve the local communities that we serve in our One Community Together webpage. C. At a legislative committee hearing today, NC Medicaid shared that the Local Management Entities (LMEs) that will run Tailored Plans – Alliance Health, Partners Health Management, Trillium Health Resources, and Vaya Health – are all ready to go live. ility Tailored Plans (Tailored Plans). For Vincent, this work is about helping people get answers and move forward with the right support. Apr 1, 2020 · Trillium Individual Rehabilitation Coordination and Support… Trillium-Individual--Rehabilitation-Coordination-and-Support-Services--4-1-2020. Beneficiaries covered by the Trillium Tailored Plan receive behavioral health, I/DD, TBI and physical health care services. Accessible rides are also available. It will not have auto approved PAs. Medicaid Expansion More people can get health care coverage through Medicaid! Watch the short video below to learn how you can apply North Carolina is changing the rules for who can get health care through Medicaid. Trillium manages services for: Medicaid members placed on the Trillium Tailored Plan. Travel outside the state is allowed but requires prior authorization and approval by Trillium Health Plan if over Providers can help you find a provider in Trillium’s network by calling Trillium at 1-877-685-2415 or the NC Medicaid Enrollment Broker at: 1-833-870-5500. Please include your phone number so our staff can double-check the information before updating our files If you need a new NC Medicaid ID card, please contact your local Department of Social Services. Your NC Medicaid ID card includes important information: Your name and NC Medicaid ID number Your primary care provider’s (PCP) name, address and phone number Trillium’s service line phone numbers Pharmacy benefit information Need help? These NC Medicaid health plans offer Tailored Care Management. Nov 24, 2025 · Medications in tier 1 and tier 2 are found on the PDL Trillium Health Resources utilizes the NC Medicaid Preferred Drug List (PDL), which allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. If my provider is out of Trillium's network, what can my provider do to help me? Provider can also help you search for another provider in the network in Trillium’s Provider Directory: NC Medicaid transitioned most Medicaid beneficiaries to Standard Plans on July 1, 2021. If you get NC Medicaid Direct services for these needs, your NC Medicaid plan may be moved to a Tailored Plan. The highest copay is $4 and that is only needed for some services. Available services include basic Medicaid services for North Carolina, plus some additional services for more serious behavioral health or I/DD conditions. Jun 20, 2024 · The Tailored Plans also serve uninsured individuals currently receiving state-funded services, regardless of their diagnosis, along with those in NC Medicaid Direct. Healthcare & Claims Professional Medicaid Billing Documentation Review Provider Support · I am a detail‑driven healthcare professional with 17 years of experience across medical and NC Medicaid Direct Handbook State-funded Recipient Handbook NC Innovations Waiver Handbook How to Get the Care You Need There are several ways to find and get services for health care. , Medicaid – HealthyBlue of North Carolina, Medicaid – Healthy Blue Care Together (HBCT), Medicaid – Trillium Health Resources, Medicaid – Vaya Health, Medicaid – WellCare of North Carolina, Inc. Wegovy is currently covered by NC Medicaid only for the reduction of major adverse cardiovascular [CV] events (CV death, non-fatal myocardial infarction, or non-fatal Jan 26, 2026 · Please be advised that Trillium has added double asterisks (**) next to the services that have unified rates across all legacy LME/MCOs. Person-Centered Planning and Care Plans/ Individual Support Plans While NC Medicaid has historically required providers to complete a Person-Centered Plan (PCP) for an individual to obtain authorization for 1915(b)(3) services, the PCP will not be used for authorization of 1915(i) services. (If you already have NC Medicaid, skip this step. NC Medicaid covers most health services. You can visit a provider in our network before contacting Trillium. The TrilliumTailored Plan provides a number physical health care services you can get. Providers are doctors or specialists. Mar 2, 2014 · Trillium allows Providers to submit a written appeal request through Trillium's online Provider portal, Provider Direct, or by mailing a copy of the request, via certified mail, to Trillium (201 West 1st. The North Carolina Department of Health and Human Services (NCDHHS) sent notices to all transitioning members in early 2024. www. This includes people on the TailoredPlan, akind of Medicaid health plan. For more information, contact your care manager or Member and Recipient Services at 1-877-685-2415 or dial 711 for TTY. Recipients can get case management if they cannot receive Medicaid and meet certain criteria. Transportation can be to any covered treatment type within the state of North Carolina. For recipients with I/DD and TBI diagnoses, Trillium provides Care Management. Please note that information may have been updated since the date of the presentations. Over 500 staff who live and work in eastern North Carolina. Tailored Care Management for Providers Provider-based care management promotes integrated care and offers Trillium members choice in how they receive care management. For more information about these agencies, contact us at the Member and Recipient Services at 1-877-685-2415. Medicaid Direct Services and State Funded Services: Providers who serve beneficiaries who are excluded or delayed populations from Medicaid managed care, will continue to receive Behavioral Health and I/DD services through Trillium Health Resources. This information may impact your level of coverage. TRILLIUM WELCOMES YOU As part of Trillium Health Resources, we are proud to continue managed care services to North Carolina’s NC Medicaid Direct population. To have your services paid for by NC Medicaid, your Medicaid providers must be in your Tailored Plan’s network (Alliance Health, Partners Health Management, Trillium Health Resources or Vaya Health). Trillium prioritizes treatment in the most inclusive setting, attention to the whole person, and concentration on an individual's strengths. Currently, the North Carolina Department of Health and Human Services (the Department), provides care management for women experiencing high-risk pregnancies through programs run by Local Health Departments (LHDs). Provider Office Hours Trillium hosted provider office hours for contracted providers. However, dual members who receive Innovations Waiver se vices or Traumatic Brain Injury (TBI) Waiver services qualify for Tailored Plans. Providers should attach any supporting documentation when required. , Greenville, NC 27858). It is always important to verify and update insurance information and know which testing laboratories are in-network or participating providers for your benefit plan. We're always available if questions arise, and we collaborate with our providers to help ensure the efficient delivery of high-quality care throughout our community. People without insurance or who are underinsured with state-funded behavioral health services. Our primary MOST PEOPLE GET MEDICAID SERVICES THROUGH A HEALTH PLAN You have access to a group of providers, 24-hour Nurse Line and can see your doctor as needed. Apr 15, 2024 · Utilize Trillium’s on-line Provider Portal, Provider Direct; Fax the appeal request to 252-215-6879; ail the appe Appeals@trilliumnc. Jul 1, 2024 · The Trillium Tailored Plan is designed to manage behavioral and physical health services for individuals on N. Total population around 1. This Notice contains information regarding such prior authorization requirements and is applicable to all Medicaid products offered. Providers should also review the Clinical Coverage Policy for specific details on services and procedures. For non-participating providers, Join Our Network. Jan 3, 2024 · Mental health services for people enrolled in Medicaid in much of southeastern North Carolina will soon be consolidated following a merger approved by the state. ) Your eligibility for the Tailored Plan will automatically be reviewed. Alliance — ModivCare: 855-759-9600 Partners — ModivCare: 855-397-3604 Trillium — ModivCare: 877-685-2415 Vaya — ModivCare: 855-397-3614 *If you are helping a member arrange transportation, call the Tailored Plan Member Services line on the member’s Medicaid ID card. tillis. Dental Services need to be verified by the State. It includes doctor visits, check-ups Jun 14, 2024 · The Trillium Tailored Plan will manage behavioral and physical health services for individuals on NC Medicaid and with the following: NC Innovations Waiver members, and those on the waitlist. Beginning Dec. Jul 1, 2024 · The Trillium Tailored Plan launched on July 1, 2024. • Will Trillium accept Provider Tailored Plan Trainings from another MCO? Dec 22, 2023 · Earlier this week, Trillium Health Resources and Eastpointe Human Services, which was already in the process of merging with Sandhills Center came together in mutual agreement to build on their collective strengths and administer state and Medicaid-funded MH/SUD/IDD/TBI services and supports in 46 counties in the combined region, effective If you suspect a doctor, clinic, hospital, home health service or any other kind of health provider is committing Medicaid fraud, report it. You must get the services below from the providers who are in Trillium’s network. Medicaid members placed in NC Medicaid Direct. If you have Trillium is committed to simplifying the administration of health insurance so our providers can devote their attention to providing health care. Metro Mental health services for people enrolled in Medicaid in much of southeastern North Access your secure account information for Trillium Community Health Plan online through our health care portal for members and providers. To check on a specific physical health service or procedure for Trillium Tailored Plan members, use the Pre-Auth Tool. Effective July 1, 2024, providers who are contracted with Trillium for Tailored Plan will submit Physical Health claims or authorization inquiries through the Trillium Physical Health Portal. Letters are sent in the mail from your Tailored Plan (Vaya Total Care, Alliance Health, Partners Health Management and Trillium Health) letting you know if you are eligible. Members and recipients also have the right to appeal decisions made about a service request. AdvaNCe Health Together is a training and collaboration model that will help Community Behavioral Health Clinics Tailored Plan Provider Resources Sharing from NC Department of Health and Human Services: The Provider Playbook is a collection of information and tools specifically designed to assist providers transitioning to NC Medicaid Managed Care. NC Medicaid Direct Members: Call your local DSS office to learn more about transportation services. ARE YOU ON NC MEDICAID DIRECT? Trillium Tailored Plan starts July 1, 2024 s, Trillium will continue to serve Medicaid beneficiaries who are not placed on the Tailored Plan. 66 (a)- (d). Free online trainings for our members, community partners, and the public. What is changing with the launch of the Trillium Tailored Plan? With the Trillium Tailored Plan, we have more ways to serve members, including physical health care and pharmacy needs. NC Medicaid pays the cost for most health care services. The PDL was authorized by the NC General Assembly Session Law 2009-451, Sections 10. As always, we are committed to being ready to serve and care for North Carolinians that Mar 15, 2026 · See Accreditation status and health plan rating for Trillium Health Resources on NCQA Report Cards. Complex imaging, MRA, MRI, PET, and CT scans need to be verified by Evolent. Through Tailored Care Management (TCM), Trillium Medicaid members will have a single designated care manager supported by a multidisciplinary care team. This fact sheet provides details on what NC Medicaid Direct is an who qualifies for NC When a member presents for service, use NCTracks to verify member eligibility and determine which Tailored Plan they are assigned. Trillium Health Resources utilizes the NC Medicaid Preferred Drug List (PDL), which allows NC Medicaid to obtain better prices for covered outpatient drugs through supplemental rebates. Handbooks Member Medicaid Direct Tailored Plan State-Funded Recipient Does Trillium pay for patients that have Medicare and Medicaid? are dually eligible for Medicare and Medicaid may be excluded from managed care. Trillium complies with applicable Federal civil rights laws and does not discriminate on the Nov 14, 2025 · How to get a Tailored Plan Apply for NC Medicaid. That’s about $1,800/month for singles and $3,065/month for families of three. The latest resources are added to the fact sheet page. gov. As always, we are committed to being ready to serve and care for North We are responsible for managing state and federally-funded services for people who receive Medicaid, are uninsured, or cannot afford services. If you clicked something by mistake, click the item again to unselect it. If a provider you need is out-of-network, talk to your Tailored Plan. We appreciate your continued partnership and commitment to members. St. Oct 14, 2025 · The North Carolina Department of Health and Human Services today announced the creation of the AdvaNCe Health Together Learning Community, a new initiative developed in partnership with national consulting firm Open Minds and Trillium Health Resources, a North Carolina LME/MCO. 22 KB - April 15, 2020 About Trillium Trillium covers 28 counties in eastern North Carolina. Dual-eligible members: “Dual-eligible” means you have Medicare and Medicaid. , Aetna, BlueCross BlueShield (BCBS), MedCost Trillium has a contract to meet the health care needs of people enrolled in NC Medicaid Direct. As a prepaid inpatient health plan, Trillium is at financial risk for a specific set of MH/DD/SA services, including both NC Medicaid State Plan services and services included in the NC Inn Trillium requires all providers to be enrolled in NC Tracks and credentialed to provide services to Medicaid beneficiaries. Medicaid and with the following: * Serious mental illness (SMI). To learn more, please view the training on My Learning Campus. Transition of Care NC Medicaid Preview 9 hours ago Transition of Care Policy. Non-participating providers must submit Prior Authorization for all services. Trillium has a contract to meet the health care needs of people enrolled in NC Medicaid Direct. Call the one listed on your health plan ID card or in your health plan welcome letter: Alliance Health, 1-800-510-9132, TTY: 711 or 1-800-735-2962 Partners Health Management, 1-888-235-4673, TTY/English: 1-800-735-2962, TTY/Spanish: 1-888-825-6570 Trillium Health Resources, 1-877-685-2415, TTY: 711 Vaya Health, 1-800-962 Dec 1, 2023 · North Carolina expanded health care coverage to more people. The plan is responsible for managing two of the State’s Medicaid Section 1915(c) Home and Community-Based Services (HCBS) waivers: the NC Innovations waiver for individuals with I/DD and the TBI waiver. Apr 3, 2024 · It’s official! Tailored Plans will launch on July 1. Medicaid – Alliance Health, Medicaid – AmeriHealth Caritas North Carolina, Inc. If you want to leave Trillium and move to another Medicaid health care option, you must leave the NC Innovations waiver first. Trillium now serves 46 counties in the combined region. Trillium works with agencies that specifically serve people who are deaf or hard of hearing. This guide should be used together with Trillium's Provider Manuals, Communication Bulletins, and guidance from the Department of Health Benefits, the Division of Mental Health and NC Medicaid Management Information System (MMIS). This can include children in fos We are designated by the NC Department of Health & Human Services to oversee state and federally funded services for 28 counties in eastern North Carolina. NC Innovations is a Medicaid Waiver program for individuals with intellectual disabilities/ developmental disabilities who prefer to receive long-term services and supports in their home or community, rather than an institutional setting. NC Medicaid Managed Care offers different health plan options. Other vendors can call Administrative & Business Matters at 1-866-998-2597 (Toll-Free) for general questions and business matters. ProviderOmbudsman@dhhs. fjbznca wioo bcdqfn oprg pdg zsmtl qorsa iwstl rozro lvxqyo