To support the mission, vision and values of the organization, Trillium is organized into functional areas called Teams. Teams incorporate experienced staff who are content experts and focused on the daily operations within their area. Functional areas consist of Business Management, Human Resources, Information Technology, Member Services, Community Development, Care Coordination, Network Management, Quality Management, and Utilization Management.
The primary purpose of the Business Management Team is the organization of the fiscal and budgetary operations of Trillium. The team is responsible for sound financial planning and for ensuring compliance with all fiscal policies at the local, state and federal levels. The Business Management Team comprises the following areas: general budget, finance, claims processing.
Care Coordination is a person-centered, assessment based interdisciplinary approach to integrating behavioral health services, and/or IDD services/supports, primary health care and natural and community social support services. This function is completed in a cost-effective manner in which an individual’s needs and preferences are assessed, a comprehensive care plan is developed, and services are managed and monitored by a care coordinator.
Care Coordination at Trillium consists of a Child and Adult Mental Health / Substance Use Department and an Intellectual /Developmental Disability Department. Care Coordinators include qualified professionals, licensed clinicians, coordinators.
Research & Development
Members of the Research & Development Team work to build natural resources that maintain sustainable community resources that support the treatment, habilitation and recovery of persons with psychiatric illness, substance use disorders and/or intellectual and developmental disabilities. This is accomplished by educating the community regarding needs of persons with behavioral health issues. It also includes network development that processes Requests for Proposals (RFPs) to bring more providers into the Trillium Network, along with securing home modification vendors.
The unit also works closely with Contract and Training Departments as these units secure all contracts (UCR, non-UCR and professional services) for providers and vendors. They coordinate training and offer these services to providers and the general public. They are responsible for reviewing addendums and contract revisions as necessary.
Trillium’s provider network is managed and maintained through efforts of the Network Team. The Network Department is responsible for the development and maintenance of the Provider Network to ensure we meet the needs of members while ensuring choice and best practices in services. The Network Department oversees the following:
- Network Services-Technical Assistance & Support
- Network Auditing
- Complaint/Grievance Investigations
- Network Contract Managers
In order to better serve providers, the Network Department has been organized into the following groups:
- Network Services: Network Service Staff responds to Network Providers concerns, questions and provide technical assistance to providers through our Network Services Ticket System NetworkServicesSupport@TrillumNC.org. Network Service Staff processes Trillium Health Resources Credentialing and Re-Credentialing Applications for Licensed Independent Practitioners (LIP), Licensed Independent Practitioner Groups, Agencies and Supplemental Clinicians. Network Providers can submit their applications to Trillium Health Resources Credentialing email: Credentialing@TrilliumNC.org.
- Network Auditing: Network Auditing conducts several different types of monitoring and reviews of providers to ensure the best possible service delivery and business practices are being carried out within our Network. These include initial site reviews, provider monitoring, UAFL reviews, monitoring of compliance with contract/business requirements, Complaint/Grievance Investigations, and provider concerns.
- Network Contract Manager: There are two Contract Managers that function as the primary contact and are responsible for management level communications/activities between Trillium and their assigned caseload of our larger providers who hold multiple contracts and need more specialized attention and support. The Contracts and Training Departments secures all contracts (UCR, non-UCR and professional services) for providers and vendors, coordinates training offered to both providers and the public, and reviews addendums and contract revisions as necessary.
Call Center & Customer Services
The Call Center & Customer Services team, called Trillium Connections, is staffed with experienced agents, qualified professionals, and licensed clinicians whose primary purpose is to give members and their families, providers, and other community stakeholders accurate and relative information in regards to Trillium, our network of providers, and the services that are available. Trillium Connections is clearly defined as a separate division with clear functions from other departments to ensure fair and impartial review of issues and actions. They are available 24 hours a day, seven days a week, 365 days a year.
Trillium Connections also assists with collecting information on complaints and grievances from members, family, guardians or providers.
In addition, the Communications and Marketing department creates printed and digital resources to educate members and their family, providers, and the public. These brochures, websites and other materials help explain the services coordinated by Trillium, along with information about Managed Care Organizations (MCO) and the Medicaid system in North Carolina.
Housing Services works with community representatives and agencies to help secure decent, safe, and affordable housing for members. Trillium Housing staff work closely with community partners to coordinate efforts, avoid duplication and obtain the best outcomes for people serve
The Quality Management Program is a comprehensive, proactive program that provides the structure, process, resources, and expertise necessary to systematically define, evaluate, monitor and ensure that high-quality, cost-effective care and services are provided to members. Additionally, they ensure that compliance with national accreditation standards is met and ongoing throughout the term of the contractual agreement.
This program includes a continuous, objective, and systematic process that:
- monitors and evaluates key indicators of care and services
- identifies opportunities for improvement
- develops and implements interventions that address the identified opportunities
- re-assess to demonstrate the effectiveness of applied program interventions
Utilization Management reviews, manages and monitors the use of mental health, substance use and intellectual/developmental disability services. UM also reviews utilization data to evaluate and ensure that services are being provided appropriately within established benchmarks and clinical guidelines and that services are consistent with the authorization and approved plan. Their goal is to ensure that members receive the right service, at the right time, at the right level, while creating the most effective and efficient treatment possible.
Program Integrity (PI) ensures the integrity and compliance of agency programs. PI maintains accountability in expenditure of funds through the prevention, detection and investigation of fraud and abuse.
Appeals responds to requests for the review of an Adverse Benefit Determination for Medicaid recipients. Medicaid recipients have the right to appeal decisions made about service requests. State-funded services are not an entitlement, but in some circumstances, denials can be appealed.
Internal Compliance confirms that departments within Trillium follow state and federal contracts, guidelines and regulations. Internal Compliance initiates annual and ad-hoc audits to ensure adherence to all of Trillium’s policies and procedures and contractual obligations.
The Human Resources team ensures Trillium is staffed with a highly competent workforce that supports its mission. Trillium retains qualified employees through a competitive salary and benefits package, training and development opportunities, and practices that treat employees with respect and equality.
The Information Technology teams strengthen Trillium’s use of information, analytics, and technology for both staff and members served. IT staff from both the Business Informatics and IT Operations teams work collaboratively across departments to:
- secure all data and ensure compliance with all IT standards;
- innovate the application of new technologies to improve organization operations;
- develop reports and applications based on business and clinical needs;
- implement software to provide staff with the tools to improve care coordination and facilitate record sharing;
- maintain databases and information systems;
- support hardware and equipment supplies for the organization; respond to provider requests for technical assistance with online portals and access;
- oversee physical plant operations
The Medical Affairs team includes Trillium’s medical officers who provide clinical oversight to all clinical components within Trillium. The medical officers ensures Trillium’s objective to have qualified clinicians accountable to the organization for decisions affecting members.
The medical officers assist in the following capacities:
- Chairperson of the Quality Improvement Committee
- Member of the Global Quality Improvement Committee
- Consultation with Utilization Management and the Call Center on complex situations
- Oversight of the Credentialing Program for Providers
- Communication of clinical policy from NC DHHS
Staff in the Medical Affairs team helped launch the Compassion Reaction and Child First initiatives, and maintain support for the schools and agencies operating these programs.