Tailored Plan Launch is Delayed
NC Medicaid will delay Tailored Plan Launch beyond October 2023. A new launch date has not been announced.
More information can be found 
here
Learn about Tailored Plan here

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Medicaid expansion will no longer launch Oct. 1 as the North Carolina General Assembly failed to take needed action to meet that date. A new launch date will be announced following the needed legislative action, but it will not be Oct. 1.
For more information, please view the press release from NCDHHS.

Breadcrumb

Provider Contact Information and Portals

How We Can Help You?

Provider Phone Numbers:

Provider Support Services: 1-855-250-1539.

Trained staff can assist with your questions, or will contact the appropriate department to answer all inquiries.

Email Provider Support: NetworkServicesSupport@TrilliumNC.org.

Providers may also submit questions via email.

NC Medicaid Provider Ombudsman: 1-866-304-7062 and Medicaid.ProviderOmbudsman@dhhs.nc.gov.  

The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding primary health providers (PHPs). The Ombudsman will provide resources and assist providers with issues through resolution. 

Other vendors can call the Administrative & Business Matters 1-866-998-2597 (Toll-Free) for general questions and business matters.

Provider Portal

Behavioral Health I/DD Provider Portal (Provider Direct)

A secure platform for mental health, I/DD, and substance use providers to access for the following:

  • Enter or upload Treatment Authorization Requests (TARs) to obtain prior authorization
  • Upload Person-Centered Plans (PCPs) and Individual Service Plans (ISPs)
  • Access and file claims 
  • Submit complaints/grievances
  • Access the provider manual 

Please see the instructions on how to access Provider Direct. All providers must complete the required training and paperwork to access Provider Direct.

Provider Manuals

Trillium’s Provider Manual includes important information including the following: 

  • How to file claims.
  • Member rights, including filing appeals and grievances.
  • Provider responsibilities.

Providers have the right to appeal certain actions that Trillium takes against them. Trillium outlines our Provider appeals processes in the Provider Manual. Trillium provides written notice of a Provider’s appeal rights with the notice of decision giving rise to the Provider’s right to appeal. Trillium allows Providers to submit a written appeal request through Trillium’s online provider portal, Provider Direct, or by mailing a copy of the request, via certified mail, to Trillium (201 West 1st. St., Greenville, NC 27858).

For more information on provider appeals, please refer to the Provider Manual, or contact Trillium’s Appeals Coordinator (1-855-250-1539).  

Provider My Learning Campus

Web-based training/education site to access recorded modules on topics Trillium deems important for Providers to complete.  Available 24/7, including training videos, quizzes, evaluations, certificates, and a record-keeping system.

To create your account and access courses, please fill out the  Provider My Learning Campus User Agreement form. 

Important Links

Clinical Practice Guidelines

Providers are expected to maintain and/or advance the quality of services through the demonstration of practice consistent with pertinent Clinical Practice Guidelines and Best Practices.

Zixmail Secure for Providers

For providers to create and send secure emails to Trillium staff. As of June 3, 2018, all internet browsers used to access Zixmail must support TSL 1.2 or higher. A comprehensive list of browsers that support TLS 1.2 is available here: Qualys, SSL Lab.

Committees

Trillium partners with medical and clinical professionals from our Network Provider organizations, as well as with members, their family members, and community stakeholders.

Utilization Management Program Policy
(new version will be posted soon)

Includes details on pharmacy clinical coverage, prior authorization criteria, and more.

NC Medicaid Provider Ombudsman
1-866-304-7062 
(Medicaid.ProviderOmbudsman@dhhs.nc.gov)  

The Division of Health Benefits (DHB) has created a Provider Ombudsman to represent the interests of the provider community by receiving and responding to inquiries and complaints regarding PHPs. The Ombudsman will provide resources and assist providers with issues through resolution.

NC Medicaid Enrollment Broker

Members may request help from providers to remain with Trillium if they are placed in the Standard Plan; NC Medicaid shares forms on this page for providers to complete and submit on member’s behalf if requested.

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If you find any wrong or out of date information on our pages, we want to know. Please email Info@TrilliumNC.org with any corrections.