Contracting with Trillium

Trillium partners with practitioners and provider agencies to build community well-being through the delivery of person-centered services and supports.  This is accomplished by Trillium and the provider entering into a contractual agreement for the provision of services. The two main types of contract agreements include the Procurement Contract and the Out-of-Network Single Case Agreement.  

Trillium maintains a closed network for Behavioral health and I/DD services. To request to join the Trillium network for BH/IDD services, please visit our Provider Recruitment or Vendor Opportunities webpage for current network openings OR email NetworkServicesSupport@TrilliumNC.org.

Procurement Contract

The Procurement Contract is issued to provider agencies and practitioners that have completed the Trillium credentialing process and deemed qualified to participate in the Trillium Provider Network.  The Procurement Contract carries a life of up to three years and is the preferred contracting method.

• Procurement Contract General Template (effective November 1, 2020)
• Appendix - G Hospital
• Appendix - G ICF/IID
• Appendix - G Agencies
• Appendix - G LIP
• Attachment - A

Out of Network Single Case Agreement*

An Out of Network Single Case Agreement (OON SCA) is an agreement between Trillium and a provider agency or practitioner not contracted with Trillium but chosen to render services to an individual enrolled with Trillium. Single Case Agreements are member specific and require prior approval from Trillium for every member served.    

NOTE: The Out of Network Single Case Agreement process is for provider agencies and practitioners that do not have a current contract with Trillium. Credentialed provider agencies and practitioners that have a current contract to be an In-Network Provider should contact Trillium Network Development to request additions to their contract. Network Development can be contacted using 1 of the following methods:  

• Email: NetworkServicesSupport@TrilliumNC.org or
• Phone: 855-250-1539

If a provider agency or practitioner still requires an OON SCA, the following steps should be completed in the order detailed below. Any deviation will cause delays in overall process.  

STEP 1: CONFIRM NCTRACKS ENROLLMENT

Every provider agency, practitioner, and supplemental delivering a service to a Medicaid eligible member or State funded recipient must be enrolled and active in NCTracks. Trillium will conduct a review of NCTracks enrollment prior to initiating the OON SCA process. Before submitting an OON SCA request, provider agencies and practitioners should confirm the following:  

1. NCTracks enrollment;
2. Provider Status is “01-Active”;
3. Taxonomy Classification will adjudicate the service(s) requested; 
4. The service address is found under Service Location as 003 or above (if applicable); and 
5. The correct rendering provider affiliations are present (if applicable).

To review your information in NCTracks visit www.nctracks.nc.gov.  

STEP 2: NCTRACKS VERIFICATION AND ESTABLISH MEDICAL NECESSITY

During Step 2, the following will occur in this order: 

1. The provider agency or practitioner will submit the required information outlined below. 
2. Trillium will verify NCTracks enrollment.
3. Based on NCTracks enrollment findings: 
   1. No Issues found – Utilization Management will complete the Medical Necessity (MN) determination, notify the provider agency or practitioner of the decision, and provide instructions for submitting the OON Request form (when applicable).
   2. Issues found – The OON SCA process will stop and Trillium will notify the provider agency or practitioner of NCTracks enrollment findings.  

To initiate Step 2, the provider agency or practitioner must contact Utilization Management (UM) and provide the following information:

Required for NCTracks verification:

• Provider Name (as listed on a W-9)
• Provider TaxID
• Provider NPI
• Provider Taxonomy
• Service Address

Required for Medical Necessity Review:

• Primary Contact at Provider Agency including phone number, email, etc.;
• Members Name, DOB, and Primary Diagnosis (ICD 10 Code);
• Service(s) Requested (including the service code);
• Number of Units Requested;
• Service Start and End Date; and
• Clinical Information to support MN including but not limited to:
  • Clinical support of service entrance criteria and/or Comprehensive Clinical Assessment
  • Treatment Plan/PCP/ISP
  • Service Order for the service being requested

Utilization Management (UM) can be contacted 1 of 3 ways:

• Email: UM@TrilliumNC.org
• Fax: 252-215-6875 
• Phone: 866-998-2597

STEP 3: SUBMIT THE OON REQUEST FORM & DOCUMENTS 

Provider agencies and practitioners should not begin Step 3 unless they have received confirmation of Medical Necessity from Utilization Management. Unsolicited OON SCA request forms will be returned as Unable to Process with instructions to contact Utilization Management. Provider agencies and practitioners are encouraged to review their information thoroughly. Incomplete request forms and missing documentation will cause delays in this process. 

Request forms and documentation can be submitted using one of the following methods:

Email: OON@TrilliumNC.org
Fax: 252-215-6887 
Mail: Trillium Health Resources, Attn: Contracts 201 W. First Street Greenville, NC 27858.

Required Forms and Documentation:

For the best results, please save the Adobe PDF form to a local drive on your computer before completing the form.

• Out of Network Single Case Agreement Request Form
• W-9
• Authorization Agreement for Direct Deposit
• Insurance Requirements and Attestation
• Trillium Code of Ethics
• Provider Direct System Administrator Designee Request Form
• Trading Partner Agreement
• Copy of current Certificate of Insurance (COI)

If you have any questions about the Out of Network Request Form or this process, please email your question to OON@TrilliumNC.org.