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
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.
|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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