Provider Outreach to Members

Some providers are encouraging patients to sign up for managed care (i.e. the Standard Plans) and listing the health plans they have contracted with to help patients with health plan selection. We welcome this engagement from our providers, but please note that not all Medicaid members are moving to managed care now. We understand receiving letters or other information from providers to sign up for a health plan is causing some confusion for our members who are not required to sign up at this time.

Members who are not required to sign up include those on the Innovations Waiver or people receiving intensive mental health or substance abuse services.

If you hear from your provider conducting outreach, we encourage you to call the NC Medicaid Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). The enrollment broker can tell you if you are required to sign up for Medicaid Managed Care at this time and can help you with making an informed choice if you are.

Appeals & Grievances

Medicaid recipients have the right to appeal decisions made about a service request. Everyone has the right to voice a concern, complaint or grievance.

Medicaid Appeals

The Medicaid member (or their authorized representative) who does not agree with Trillium’s Adverse Benefit Determination decision is eligible to go through the Trillium Reconsideration Process. This is guaranteed under the North Carolina Mental Health/Developmental Disabilities/Substance Abuse Services Health Plan 1915(b) and NC Innovations Home & Community Based Waiver 1915(c).

You must first go through the Trillium Reconsideration process before using the State Fair Hearing process.  Reconsiderations are decided by health care professionals with appropriate clinical expertise in treating your condition or disorder.

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