Benefit Plans | Service Definitions


Benefit Plan Information

Medicaid Benefit Plan

State-Funded Benefit Plan

Physical Health Plan

Personal Care Services

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.

Behavioral Health Services   |  Physical Health Services 

Service Definitions 

In Lieu of Services (ILOS) and Alternative Services

Service Definitions

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)

Trillium welcomes feedback regarding the current Benefit Plans and Service Definitions. Feedback and recommendations will be taken into consideration and can be sent to

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