Tailored Plans - Information for Providers
The Trillium Tailored Plan launched on July 1, 2024.
We invite you to join us for Provider Office Hours. This recurring weekly meeting with Trillium leadership will provide you with resources and answers as you navigate the Tailored Plan process. We look forward to (virtually) meeting you.
Sessions will be held weekly (Wednesdays) from July 24, 2024 through August 14, 2024.
Please note: These events are for contracted providers only.
Please join each week by clicking on the date below
Please view links below for information on about training opportunities, changes to our processes, and organizational updates. Please be sure to sign up to receive Network Communications Bulletins. Our special “Medicaid Transformation Updates” share specific information about Tailored Plan launch.
See more information below:
If you have questions for NC DHHS or the Provider Ombudsman, you can email them at:
Key Date for Transitioning Tailored Plan Launch
- 4/13: Tailored Plan (TP) Auto Enrollment.
- 4/15-5/15: TP Primary Care Provider (PCP) Choice Period.
- 4/17: Enrollment Broker begins mailing transition notices.
- 5/16: Members begin scheduling Non-Emergency Medical Transportation / PCP Auto Assignment Begins.
- 5/23: Tailored Care Management (TCM) Auto Assignment Begins.
- 5/29-6/13: Member ID Cards and Welcome Packets Mailed.
- 6/1: Nurse, and Pharmacy Call Lines Go Live.
- 7/1: TP Managed Care Launch and Health Opportunity Program (HOP) TP Launch
- 9/30: Flexibility end dates for the following: (please click here for more information):
Medical Prior Authorizations:
Provider fails to submit PA prior to the service being provided and submits PA after the date of service.
Provider submits for retroactive PA.
*This exception does not apply to concurrent reviews for inpatient hospitalizations, which should still occur during this time period.
Pharmacy Pas
Out of Network Provider Rates for Medicaid-eligible nonparticipating/out of network providers - 1/31/2025: OON and PCP Changes (please click here for more information):
Out of Network Providers Follow In-Network PA Rules: Between July 1, 2024, and Jan. 31, 2025, Tailored Plans will permit uncontracted, out-of-network providers enrolled in NC Medicaid to follow in-network provider prior authorization rules. Starting on Feb. 1, 2025, out-of-network providers must seek authorizations for all services.
Primary Care Provider (PCP) Changes: Between July 1, 2024, and Jan. 31, 2025, Tailored Plan members may change their PCP for any reason.
The NC Medicaid Enrollment Broker webpage is now live. This new information will help members in selecting a health plan if they are placed on the Standard Plan.