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.

Mental Health & Substance Use

son leaning on father shoulderPERSON-CENTERED | MEDICALLY NECESSARY

Just as building a strong house requires a variety of materials, building well-being requires community resources, social relationships, and opportunities to thrive. Well-being needs a sturdy foundation at the start to prevent issues and keep it standing through all kinds of weather.

Trillium coordinates services for adults and children to address mental health and substance use (MH/SU) challenges.  To ensure people receive the services they need in a timely manner, we employ clinically-trained and licensed staff to manage and authorize those services.

Trillium requires priority admission to all women who are pregnant and injecting drugs, pregnant and using substances and other individuals who are injecting drugs.

Care Coordination and Care Management

Care coordination is a major function at Trillium.  It is a proactive, person-centered, assessment-based approach to integrating medically-necessary behavioral health services, primary health care and natural and community social support services. We prioritize finding the right individualized care for the people we serve.

Our Care Management Department includes three regional teams with integrated staff serving members with mental health, substance use, and intellectual/developmental disabilities. Rather than separate groups focused on individual populations, the new arrangement allows for a cohesive structure to facilitate communication around a variety of issues and identify any barriers to a successful recovery.

Individuals who need intensive services are assigned to a Care Coordinator.  This includes individuals recently hospitalized with MH/SU diagnoses and children at risk of or placed out-of-home. Most Care Coordination functions occur over the phone. Our team of Care Coordinators assists individuals and families in the following ways:

  • Provide education regarding MH/SU, including recovery-oriented supports and natural or community supports;
  • Ensure members receive a quality, comprehensive assessment that identifies symptoms and diagnosis, how those symptoms affect daily life, and the person’s strengths and treatment needs;
  • Link to community and natural supports;
  • Monitor the Person-Centered Plan or Treatment Plan;
  • Request and monitor the Crisis Plan developed between the provider and the member;
  • Assist in the discharge planning process for individuals hospitalized for behavioral health reasons to ensure success in their recovery;
  • Link the member to needed psychological, behavioral, educational, and integrated health care services;
  • Assist with coordination of all Medicaid benefits, including primary care engagement;
  • Monitor the treatment provided ensuring the health and safety of the member, the person’s satisfaction with care and services, and that services are delivered as specified in the plan;
  • Collaborate to address obstacles to successful recovery

Types of services our Care Coordinators assist individuals and families with include:

  • Assertive Community Treatment Team
  • Day Treatment
  • Detoxification Services
  • Diagnostic Assessment
  • Facility-Based Crisis Services
  • Intensive Alternative Family Treatment
  • Intensive In-Home Services
  • Mobile Crisis Management
  • Medication Management
  • Multi-Systemic Therapy
  • Outpatient Opioid Treatment
  • Partial Hospitalization
  • Psychosocial Rehabilitation
  • Substance Abuse Comprehensive Outpatient Treatment Program
  • Substance Abuse Intensive Outpatient Program
  • Outpatient services
  • Peer Support Specialist Services
  • Community Support Team
  • Supportive Employment

Utilization Management (UM)

We have a team of Master’s level licensed clinicians, called UM Care Managers, who review Treatment Authorization Requests (TARs) for medical necessity. In most cases, this is done prior to the provider delivering a service to a member. During the review process our UM Care Managers follow guidelines set forth by state governing agencies and Trillium.

Resources our Care Managers use include:   

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Help Stop Fraud & Abuse

You can help keep fraud, waste, abuse, unethical, or illegal activity out of our workplace. If you are uncomfortable communicating a concern in person, report it anonymously by calling the toll-free hotline number, 1.855.659.7660, or report it online at EthicsPoint and follow the instructions on the screen