Provider Communication Bulletin 003
Content
- NC Health Connex Direct Secure Messaging Session
- Carolina Complete Health and Trillium Health Resources—Provider Update and Upcoming Information Sessions
- Roadmap 2 Ready June 2026
- Public Comment Notice: Policy 8F – Research-Based Behavioral Health Treatment for Autism Spectrum Disorders
- IRIS Reminders for Providers
- Provider My Learning Campus Reminder
- Need to Report Fraud, Waste, and Abuse?
NC Health Connex Direct Secure Messaging Session
We want to make you aware of two upcoming sessions related to NC Health Connex Direct Secure Messaging (DSM). The July 14 Learning Collaborative, hosted by DHB, will focus on the value of NC Health Connex DSM and how it enhances communication between Care Managers and Primary Care Physicians (PCPs). Sharing CMCAs and Care Plans/ISPs with PCPs is a care management requirement, and NC Health Connex DSM is one option Care Managers can use to share these documents securely.
NC Health Connex has confirmed that all certified TCM providers have DSM functionality. Each TCM provider has at least one Participant Account Administrator (PAA) responsible for managing DSM access and permissions for their Care Managers. DHB will host a PAA-focused session, led by NC Health Connex, on June 22, 2026, from 2:00 p.m. to 3:00 p.m.
This session will provide practical guidance on DSM permissions, role assignments, and common questions PAAs may encounter when setting up access for Care Managers. Because Care Managers’ ability to use DSM depends on PAAs assigning the correct permissions and roles, this session is designed to ensure PAAs have the information needed to enable full functionality for their teams.
DHB is sending an email invitation with meeting details directly to the PAAs. Registration is not required, but you may find the link here.
Carolina Complete Health and Trillium Health Resources—Provider Update and Upcoming Information Sessions
We are sharing an important update regarding Trillium Tailored Plan physical health services that will impact all physical health providers, including those contracted with Trillium through Carolina Complete Health.
What’s Changing?
Effective October 1, 2026:
- All claims for Trillium Tailored Plan members must be submitted directly to Trillium through a unified claims platform.
- Providers will no longer submit claims to Carolina Complete Health for these members.
- Some physical health authorizations must be submitted to Trillium through the new unified claims system portal. Some authorizations for specialty services will continue to be sent to Carolina Complete Health or other partners.
This change applies to Trillium Physical Health Providers, regardless of current CCH participation
** The only exceptions are NEMT and vision vendors. These claims will continue to be processed by ModivCare and Centene Vision, respectively. **
Contracting Update
- Trillium is transitioning to direct provider contracting via Clearlink Partners.
- Providers not contracted directly may continue under existing Carolina Complete Health agreements, with Trillium serving as payer.
What This Means for You
- Claims and some authorizations must be submitted to Trillium beginning October 1, 2026.
- Your services remain the same, only submission processes change.
- Workflow and system updates will be required.
Next Steps
- Attend the Trillium Physical Health Information Session on June 23 or July 28 to learn more about the claim submission changes. Register Here
- Watch for contracting outreach from Clearlink Partners.
- Stay tuned for training and additional guidance.
Key Reminder
Even if you are contracted with Trillium through Carolina Complete Health, you must transition to submitting claims and some authorizations to Trillium for Trillium Tailored Plan members.
To ask questions, send a message using the questions form linked on our webpage. We will collect all questions to post in an FAQ.
Roadmap 2 Ready June 2026
Each month, we cover a topic that is a part of the Centers for Medicare & Medicaid Services Emergency Preparedness Rule.
Hurricane Season is here! Take a look at the National Oceanic and Atmospheric Administration forecast here. Although they are predicting a lower-than-average year, that does not mean there is no risk. Just one storm can make a big impact on our communities.
Take this time to review your agencies’ emergency plans, train and review plans with your staff, talk to your members or consumers, and don’t forget to prepare personally. Part of any residential provider's plans requires identifying backup evacuation locations. Take this time to check in on your backup locations, talk through what that would look like, and review the memorandum of understanding (MOU) should they be needed. For more information on building relationships and MOUs please visit, Center for Medicaid & Medicare Services.
If you have not already submitted your Disaster plans by May 1 to the 2026 Disaster Plan Submission, please do so as soon as possible. To confirm your disaster plan was received, just check the "send me a copy of my responses" option at the end of the form.
Reminders
Public Comment Notice: Policy 8F – Research-Based Behavioral Health Treatment for Autism Spectrum Disorders
NC Medicaid has released the draft Clinical Coverage Policy No. 8F: Research-Based Behavioral Health Treatment (RB-BHT) for Autism Spectrum Disorder. Posted on May 15, 2026, the policy is now open for public comment through June 14, 2026. Stakeholders are encouraged to review the draft policy, NC Medicaid 8F - Behavioral Health Treatment for Autism Spectrum Disorder and submit comments to medicaid.public.comment@dhhs.nc.gov during the open period. Your input will help shape future Medicaid coverage for evidence-based behavioral interventions for individuals with ASD.
Trillium encourages providers to view the NCDHHS Ensuring Person-Centered Care for Children with Autism in NC Medicaid webinar presentation and recording, which was held on May 12, 2026.
IRIS Reminders for Providers
IRIS Alerts
Visit the Live IRIS site and the IRIS Training site.
New Updates
- When the IRIS report is completed, please ensure the incident report is submitted through the Supervisor Actions: Incident Submission tab. Once the Submit Incident Report button is clicked, IRIS will give a thumbs up to provide confirmation that the incident report was successfully submitted.
- Please remember that an Incident Number does not confirm an incident
- If you do not have access to the Incident Numbers, you can request them to be sent to the provider.
IRIS Reporting Timelines
- Level 2 Incidents—An IRIS report must be submitted within 72 hours of learning of the incident.
- Level 3 Incidents—Verbal or written (email) notification to Trillium within 24 hours of learning of the incident. An IRIS report must be submitted within 72 hours of learning about the incident; however, for incidents involving allegations against staff, the IRIS report must be submitted within 24 hours of learning about the incident (to meet HCPR reporting timelines).
Trillium’s Reporting Expectations
- All reports must be submitted on time (zero late submissions). If a report is submitted outside of the 72-hour required timeframe, please provide a statement in the IRIS report regarding the submission of the incident outside reporting timeframe.
- All required fields (DOB, gender, incident details, cause of incident, incident prevention, authorities contacted, etc.) must be completed in IRIS for Trillium to process and close the report.
- Please ensure member’s LME-MCO record number, Medicaid ID and/or CNDS ID is completed on the Consumer’s Treatment tab.
- On the Provider Information tab, please ensure the Provider Agency name is entered in full and how it appears on the contract/license etc.
- When a report contains allegations of abuse/neglect/exploitation against staff, the internal investigation report is required to be uploaded to the IRIS report within 5 working days.
- Response to Trillium’s questions must be provided within 24 hours of receiving an email or phone call regarding an incident. Please note, failure to respond to follow up questions or complete required elements may result in referral to Compliance.
Reminders
- If staff is in a car accident while providing services to a member, an incident report is required to be submitted in IRIS. Even if the member does not require medical treatment, it is an expectation that the incident is reported to law enforcement and medical treatment is offered. These incidents meet criteria for a level II incident and can be submitted as “Consumer Injury-Auto Accident.”
- On the Provider Information tab, please ensure the correct plan/service that the member is enrolled in is selected. This will ensure the IRIS report is directed to the proper Health Plan or LME-MCO for review.
- When selecting the “Host” LME-MCO and the “Home” LME-MCO on the Provider Information tab in IRIS, please remember that the “Host” LME-MCO is the county where services are being provided and the “Home” LME-MCO is the county of residence where the member’s Medicaid is linked to.
- For Allegations of Abuse/Neglect/Exploitation against Staff, please ensure that both of the questions listed on the Incident Information tab, “Does this incident include an allegation against Staff and/or Facility?” and “Will this allegation require a submission of a Consumer Incident Report?” are both checked YES. Then complete the abuse tab and all three tabs under the HCPR tab.
For Member Deaths, please upload the death certificate and/or Medical Examiner report upon receipt and update the death information tabs accordingly. - Medical illness is not reportable unless it results in injury or death or is believed to be caused by abuse/neglect or medication error.
- For Member Injury, please elaborate on the type of treatment (i.e., stitches, cast, prescription medication) that the member receives for the injury (treatment does not include diagnostic tests such as blood work, x-ray, MRI, EKG, etc.).
Please visit Trillium’s My Learning Campus to access Incident Reporting Training for your agency staff.
For any incident related questions, please contact:
- Julie McCall for IRIS counties: Jones, Pamlico, Craven, Pitt, Beaufort, Hyde, Dare, Tyrrell, Washington, Martin, Bertie, Chowan, Perquimans, Pasquotank, Currituck, Camden, Gates, Hertford, Northampton, Halifax, and Nash.
- Cedric Johnson for IRIS counties: Bladen, Columbus, Brunswick, New Hanover, Pender, Onslow, and Carteret.
- Christy Way for IRIS counties: Anson, Hoke, Lee, Montgomery, Moore, Randolph, and Richmond.
- Debbie Powell for IRIS counties: Guilford.
- John English for IRIS counties: Edgecombe, Wilson, Robeson, Scotland, and Greene.
- Veronica Murphy for IRIS counties: Duplin, Lenoir, Sampson, Warren, and Wayne.
Provider My Learning Campus Reminder
To find updated and current Provider Trainings, please visit: Provider My Learning Campus or this list of provider trainings.
NEED TO REPORT FRAUD, WASTE AND ABUSE?
EthicsPoint is a secure and confidential system available 24 hours a day, 7 days a week for anyone to report suspected violations of potential fraud, waste and abuse, or confidentiality issues. You can access EthicsPoint through website submission at EthicsPoint - Trillium Health Resources or by calling toll-free: 1-855-659-7660.