Benefit Plans | Service Definitions
Benefit Plan Information
Medicaid Benefit Plan
- Medicaid 1915(i) - Option Set of Services
- Medicaid Acute Behavioral Health Service
- Medicaid Adult Behavioral Health Services
- Medicaid Direct B3 Behavioral Health Service
- Medicaid Outpatient Behavioral Health Services
- Medicaid Child Behavioral Health Services
- Innovation Waiver Services
- Medicaid Child and Adult Non-Innovations Services
- Medicaid Substance Use Specific Services
State-Funded Benefit Plan
- State-Funded Acute Behavioral Health Services
- State-Funded Adult Behavioral Health Services
- State-Funded Child Behavioral Health Services
- State-Funded Child and Adult Non-Innovations Services
- State-Funded Outpatient Behavioral Health Services
- State-Funded Substance Use Specific Services
Physical Health Plan
- Physical Health Plan (Carolina Complete Health)
Personal Care Services
About Personal Care Services (PCS)
Trillium Health Resources also coordinates Personal Care Services for Medicaid members placed on the Tailored Plan.
If you are seeing a member in need of these services, please complete the following information for questions related to NC State Plan Personal Care Services. Please complete the DHB 3051 Request for Independent Assessment Form when referring for a PCS assessment or reassessment. The form can be emailed to LTSS@trilliumnc.org using the “Submit” button on the form, or by saving to your desktop and emailing as an attachment.
If you have general questions about the Personal Care Services, please submit using the link below and someone will contact you within 1-3 business days with a response.
If you have general questions about the Personal Care Services, please submit using the link below and someone will contact you within 1-3 business days with a response.
Personal Care Services Questions
Prior Authorization Services
Please use this tool to determine if prior authorization is required for specific services and codes. However, using this tool does NOT guarantee payment. Member eligibility, benefit plans, codes in provider contracts, and other details may impact payment. Please refer to the provider manual or call the Provider Support Service Line at 1-855-250-1539 for more information.
Service Definitions
- Service Definitions
- Medicaid Clinical Coverage Policies
- B3 Service Definitions
- 1915i Home and Community-Based Services
In Lieu of Services (ILOS)
- Behavioral Health Crisis Assessment and Intervention (BH-CAI)
- Community Living Facilities and Support (CLFS)
- Family Centered Treatment
- Family Navigator
- High Fidelity Wraparound
Tailored Plan Medicaid Member Pharmacy Benefits
Medicaid Member Pharmacy Benefits - Prescription drugs, over-the-counter medicines, and other supplies covered for Medicaid members.
Services for Medicaid–Eligible Children: Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
- Medicaid covers a broad array of health and dental services for those under age 21. A federal law requires Medicaid to provide all medically necessary health care services to Medicaid-eligible children. This is called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), which is known in North Carolina as "Health Check." The services are required even if the services are not normally covered by the children's Medicaid.
- For more information about Health Check and EPSDT in North Carolina, visit our page Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Utilization Management
Trillium's Utilization Management (UM) Department reviews all treatment authorization requests for members or recipients in our region.
UM decisions are made by qualified health professionals. Trillium’s licensed clinicians and behavioral healthcare professionals gather only relevant and necessary clinical information to make decisions about the medical necessity of requests. “Medical necessity” means necessary for the treatment or diagnosis of a health condition.
For more information see our Clinical Review Criteria and Utilization Management Program Policy.
Trillium welcomes feedback regarding the current Benefit Plans and Service Definitions. Feedback and recommendations will be taken into consideration and can be sent to QMinfo@TrilliumNC.org.
