The Trillium Tailored Plan launches on April 1, 2023.
NC Medicaid changed the start date for Tailored Plans. The new start date is April 1, 2023. Until April 1, 2023, you will keep getting services the way you do now.
Information and processes on this page will be changing in the weeks to come. 
Learn about Tailored Plan here

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Trillium has launched our Emergency Operations in preparation for Hurricane Ian. Trillium’s Member and Recipient Services will remain active and will switch to only operating that number (1-877-685-2415) if required due to power outages. If conditions worsen, we encourage everyone to use staff emails to keep Member & Recipient Services open. In all areas, 911 should be used for TRUE MEDICAL EMERGENCIES. Trillium staff are not first responders and will not be able to physically attend to emergencies in the community.


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Provider Tailored Plan Contracting Reminders

PROVIDER CONTRACTING REMINDERS

Trillium will start sharing information soon with providers about changes to come in the contracts, both the services included and processes such as credentialing.

Please note: if you are currently contracted with Trillium, you may also need to research contracting with at least one of the Standard Plan PHPs; after July 1, 2021, if a member has been placed on the Standard Plan providers will no longer be able to bill Trillium for services.

TAILORED PLAN PROVIDER CONTRACT

The new Tailored Plan Provider Manual has been posted on Provider Learning Campus and in Provider Direct. Those providers who have signed and executed a Tailored Plan contract can view the new manual now. 

Please note: The Tailored Plan Provider Manual will not be in effect until Apr. 1, 2023. There will be a watermark on the new manual until that time.

In anticipation of Tailored Plan launch expected to occur on April 1, 2023, and to ensure Trillium will meet the Network Adequacy requirements, Trillium will begin issuing the NCDHHS approved Tailored Plan Procurement Contract (“TP Provider Contract”) to its fully contracted providers in June 2022. The effective date of the TP Provider Contract will be April 1, 2023, and providers will continue serving Trillium members under the terms and conditions of their current procurement contract until that time.

Per NCDHHS, there is a 90-day Opt-Out period from when you receive the new Tailored Plan contract. However, a quicker response is desired and will assist Trillium to ensure network adequacy.

Rejecting participation in any program shall not have any impact upon the provider’s ability to continue participation under other programs, and any questions can be submitted to Provider Contracting Questions and Feedback

In an effort to aid in the review of the terms and conditions that will be changing, we created a Quick Reference Guide. While this guide does not capture every edit, it does highlight changes that have the potential to increase provider issues for meeting contracting requirements, service delivery, claims, and reimbursement.

Please forward any questions regarding the TP Provider Contract or the contracting process to TP Provider Contracting Questions and Feedback or call the Provider Support Services Line at 1-855-250-1539.

Note: The contract template is subject to change as the Department issues additional guidance. Trillium will communicate such changes in a Trillium Network Communication Bulletin and incorporate the changes, when applicable, in an addendum. Additionally, while some of the language can be negotiated, most of the revised language is required by the Department to be verbatim.

Combined Medicaid and State Contract Template
General Terms and Conditions Appendix F Hospital Addendum
Appendix A Federal Assurances Certification Regarding Environmental Tobacco Smoke Appendix G Business Associate Addendum
Appendix B Federal Assurances Certification Regarding lobbying Attachment A Contracted Services and Approved Sites
Appendix C Federal Assurances Certification Regarding Drug-free Workplace Requirements Attachment B Deficit Reduction Act
Appendix D Federal Assurances Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions Attachment C Advanced Medical Home Program Policy for Medicaid and NC Health Choice Members
Appendix E Outcomes and Reporting Requirements Attachment D Pregnancy Management Program Policy for Medicaid and NC Health Choice Members
Appendix F Agency Addendum Attachment E Care Management for High-Risk Pregnancy Policy for Medicaid and NC Health Choice Members
Appendix F Practitioner/Group Addendum Attachment F Care Management for At-Risk Children Policy for Medicaid and NC Health Choice Members
Appendix F ICF Addendum Attachment G Indian Health Care Providers

Trillium aims to develop a robust integrated network of providers and maintains an open network for all physical health providers. To join the Trillium network, for physical health services, please contact NetworkServicesSupport@TrilliumNC.org.

During the beneficiary choice period (Aug. 15, 2022, through Oct. 14, 2022) for Tailored Plan Launch, beneficiaries can choose a primary care provider (PCP) and Tailored Care Management provider by contacting their Tailored Plan. Beneficiaries who do not make a choice will be automatically assigned (auto-assignment commences on Oct. 15, 2022, and runs for six days) a Tailored Care Management provider and a PCP.

Provider contracts must be signed and mailed to the Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans by:

  • July 16, 2022, for inclusion in the initial beneficiary choice period.
  • Sept. 15, 2022, for PCP inclusion in auto-assignment.
  • Sept. 30, 2022, for Tailored Care Management inclusion in auto-assignment.

Trillium maintains a closed network for BH/IDD 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.

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