Guidelines | Forms | Links
Providers Manuals
Please note requirements covered for the Trillium Tailored Plan are not effective until Tailored Plan launch
Forms
- 837I Institutional Health Care Claim
- 837P Professional Health Care Claim
- Authorization Agreement for Direct Deposit
- Claims Request Form
- Claims Request Form Instructions
- Claims Request Form Purpose
- Deficit Reduction Act Attestation
- Known Issues Tracker
- Request for Taxpayer - W9
- Provider Claims Split
- Remittance Advice (RA) Companion Guide
- Submission Address for Paper Claims (Out-of-State Providers) Effective May 15, 2023
- Replacement-Voided-Denied Claims Process
- National Correct Coding Initiative (NCCI) Fact sheet
- Taxonomy Claim Submission Fact Sheet
- Tailored Care Management Billing Guide
- System Administrator Designee Request Form
- Trading Partner Agreement
- Learning Campus User Agreement
Please note: We also have a new process to request new users for Provider.MyLearningCampus.org. - Provider Direct Terms and Conditions Instructions
- Access Provider Direct Instructions
- Request access SFTP Claims Care Management
- 835 Response file redirect to approve clearinghouse
- ZixMail Instructions
- Child First® Request for Service Form
- Consent for Release of Member Information
- Consent for Release of Member Information (Español)
- Critical Incident / DHHS Incident and Death Report
- Cultural Competency Plan FY-2022-23
- HIPAA Work Area Privacy Safeguards
- IRIS Resources
- Innovations Waiver Verification of Relative/Legal Guardian
- Independent Practitioner Referral Form
- LOC Eligibility Determination NC Innovations Form
- Medicaid Clinical Coverage Policies 8A-8P
- NCDHHS NC SNAP - Assessment website
- Trillium NC SNAP Training Eligibility and Registration Forms
- NC-TOPPS: Services Requiring It
- NC-TOPPS: Important Users Link
- NC-TOPPS Implementation Guidelines
- Non-Covered State Medicaid Plan Services Request Form for Recipients under 21 Years Old
- Notification of Out-of-Home Placement Form
- Person-Centered Forms & Publications
- Plan of Correction
- Record Retention Form
- Records Management & Documentation Management
- Regional Referral Form for Admission to a State Psychiatric Hospital or ADATC
- Treatment Authorization Request (TAR) Form
- Worksheet for Requesting Exceptions to the Diversion Law (SB 859)
- Family Disaster Plan
- HIPAA
- Incident Response Improvement System (IRIS) Resources and Forms
- Incident Response Improvement System (IRIS)
- NC Division of Health Benefit
- NC Division of Mental Health, Developmental Disabilities & Substance Abuse Services
- NC Tracks
- Trillium FAQ for NC Tracks
The “NCTracks Q and A” listserv is designed for LME/MCO use only, not for provider agencies. Provider agencies should call 1-800-688-6696 for technical assistance.
- Trillium FAQ for NC Tracks
- NC Innovations Incident Report for Failure to Provide Back-up Staff
- NC-TOPPS
- New Involuntary Commitment Process (effective October 1, 2019)
- Provider Monitoring Process
- Psychiatric Recruitment Opportunities for Providers (Loan Repayment Incentives and Practice Opportunities)
- School of Government LME Programs
- Training on - CMS Condition of Participation for PRTFs - March 16, 2016
SAMHSA
Trillium requires priority admission to all women who are pregnant and injecting drugs, pregnant and using substances, and other individuals who are injecting drugs.
Page last verified on