PLEASE NOTE:
Tailored Plan launch has been moved from Dec. 1, 2022, until Apr. 1, 2023. More information will be shared with providers soon.
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.
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.
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 April 1, 2023. There will be a watermark on the new manual until that time.
In anticipation of Tailored Plan launch expected to occur on December 1, 2022, 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 December 1, 2022, 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.
| 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.
- September 15, 2022 - for PCP inclusion in auto-assignment.
- September 30, 2022 - for Tailored Care Management inclusion in auto-assignment.
- January 5, 2023 - Last day for providers to have fully executed contracts with Tailored Plans for inclusion in the first day of the beneficiary choice period.
- January 15, 2023 - Tailored Plan auto-enrollment and Beneficiary Choice Period begin. Beneficiaries can choose a PCP by contacting their Tailored Plan.
- January 15, 2023 - Last day for PCPs to have fully executed contracts with Tailored Plans for inclusion in PCP auto-assignment.
- January 23, 2023 - Enrollment Broker begins mailing Tailored Plan Enrollment Packets to beneficiaries.
- February 14, 2023 - Last day for beneficiaries to choose a PCP before auto-assignment.
- Post-February 15, 2023 - PCP auto-assignment for beneficiaries who have not chosen a PCP.
- April 1, 2023 - Tailored Plan launch.
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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