Thank you for your interest in enrolling to provide services in the Trillium Health Resources provider network. Prior to contracting or provision of services, providers and practitioners must be credentialed for professional qualifications and have a direct contract with Trillium or be affiliated with a contracted provider. The credentialing process at Trillium is based on governing accreditation credentialing standards and incorporates contractual and policy requirements set forth by the NC Department of Health and Human Services (DHHS).
For best results, please save the Adobe PDF form to a local drive on your computer before completing the form.
What would you like to do?
Trillium Health Resources operates as a closed network at this time, allowing for prioritized focus on identified areas of need, the quality of service providers, and sound fiscal management. Currently, we are not accepting unsolicited applications for network membership. However, targeted service needs may be identified periodically and posted to Trillium’s RFP/RFA/RFI Opportunities page on the website. Needs may also be communicated through Network Communications Bulletins. Any provider (including those not contracted with Trillium) can sign up to receive these communications to stay updated on Trillium network needs.
The credentialing process begins when a prospective provider or independent practitioner has been approved by the Network Development Department to be credentialed and/or contracted. All applications should be submitted via email to Credentialing@TrilliumNC.org. Any applications received via fax, mail, delivery service, or by dropping off at a Trillium office will not be accepted. The omission of any required application information will deem the application to be incomplete and it will be returned. Trillium can only process and approve COMPLETE applications.
Providers - The following forms should be submitted when credentialing an agency or a group of practitioners operating under a unique Employer Identification Number (EIN). Please do not submit an application without written approval from Trillium Health Resources. Unsolicited applications will be returned and deemed unable to process.
Practitioners - The following forms should be submitted when credentialing a practitioner affiliated with a provider OR when independently contracted practitioners have been approved to join the network. Current in-network providers and groups of practitioners can request to add practitioner affiliations at any time. For Licensed Independent Practitioners, please do not submit an application without written approval from Trillium Health Resources. Unsolicited Independent Practitioner Credentialing applications will be returned and deemed unable to process.
Providers and practitioners are credentialed for a total of three (3) years. It is the responsibility of the provider and practitioner to take the necessary steps to ensure that the credentialing status does not lapse before the three (3) year period ends.
Providers and/or practitioners who do not return the completed recredentialing packet prior to their expiration date are required to cease billing for Medicaid-reimbursable services. Providers and practitioners are required to maintain their credentials for their organization and/or staff. Failure to comply with this contractual requirement can result in, but is not limited to, loss of revenue, recoupment, suspended contract, and/or disruption in services for Trillium members.
All applications should be submitted via email to Credentialing@TrilliumNC.org. Any applications received via fax, mail, delivery service, or by dropping off at a Trillium office will not be accepted. The omission of any required application information will deem the application to be “incomplete” and it will be returned.
Providers - The following forms should be submitted when recredentialing an agency or group of practitioners operating under a unique EIN.
Practitioners - The following application should be submitted when recredentialing a practitioner (those affiliated with a provider and those independently contracted.
- Removal of a Clinically Licensed Practitioner - This form should be submitted when the affiliation between the organization and the licensed practitioner has ended.
- Request to Add a Practitioner - This form should be submitted when a practitioner wants to be affiliated with an agency or group of practitioners.
When credentialing or recredentialing, Nurse Practitioners (NP) who are not certified as a Psychiatric Mental Health Nurse Practitioner must complete the Nurse Practitioner Requirements & Attestation Form.
This attestation ensures that each Nurse Practitioner:
Has a signed supervision agreement with a North Carolina licensed psychiatrist.
Has three (3) full-time years of psychiatric care and prescribing experience under licensed psychiatric supervision including psychiatric assessments and psychotropic medication prescribing (a waiver can be requested for this requirement).
Has met continuing education requirements, annually, which includes 20 hours each year focused on psychiatric physiology, diagnosis, and psychopharmacology.
- What is the process for adding a practitioner to my agency or group?
- Ensure NC Tracks is active and updated as required.
- To add a new clinician, a Practitioner Credentialing Application should be submitted.
- To add a clinician that is already credentialed with Trillium Health Resources, a Request to Add form should be submitted.
- What information is needed to complete the “Who Shares Call with You” question on the credentialing application?
- The person(s) who would cover for the practitioner while he or she is unavailable to members must be provided. This person would need to be of like licensure or higher and must be credentialed with Trillium Health Resources. This is NOT optional and N/A is not an acceptable answer.
- What are the rules related to Supervision Contracts and Provider Reference Forms for provisionally licensed practitioners?
- Two (2) provider reference forms and a supervision contract must be submitted. One of the provider reference forms must to be completed by the supervisor of the associate licensure. The supervision contract has to be from the respective licensure board.
- What is the process to inform Trillium of staff changes?
- The Removal of a Clinically Licensed Practitioner form must be submitted indicating desired changes with effective dates.
- How does Trillium inform providers of openings for new services?
- What happens if my credentials expire?
- If a provider or practitioner’s credentialing expires, billing must cease. Trillium will seek recoupment for services rendered/billed during the period of expiration. Trillium values our providers and practitioners and offers training and guidance from the start of this partnership. Providers/practitioners have 30 days to submit an initial credentialing application to regain credentialed status. Recredentialing applications cannot be accepted once credentialing has expired. Please access the Trillium Provider Manual
- Why is my application being returned?
- Applications are returned due to missing documents, unanswered questions on the application or forms, or NC Tracks issues. Please refer to the email that the Credentialing Specialist sends for specific instructions pertaining to the incomplete application.
- How long does it take to be credentialed?
- Once a completed application is received, the credentialing process can take up to 60 days. Providers and Practitioners cannot provider services or file claims until credentialing is approved. The Credentialing Effective Date is the date that Trillium approves the credentialing status, not the date of application submission. Providers/Practitioners are notified within ten (10) business days of credentialing decisions.
- How do I know when I am credentialed?
- You will receive an official approval letter via email within ten (10) business days of approval.
- Who needs to be credentialed?
- Medical Doctors (M.D., DO)
- Practicing Psychologists (Ph.D. and PsyD.)
- Psychologist Associates (Master’s Level Psychologist [LPA])
- Licensed Clinical Social Workers (LCSW/LCSWA)
- Licensed Marriage and Family Therapists (LMFT/LMFTA)
- Licensed Professional Counselors (LPC/LCPA)
- Licensed Clinical Addictions Specialists (LCAS/LCASA)
- Certified Clinical Supervisors (CCS)
- Advanced Practice Psychiatric Clinical Nurse Specialists
- Psychiatric Nurse Practitioners
- Licensed Physician Assistants
- Behavioral health group practices and agencies that employ individuals with various degree types and other credentials to deliver MH/SA/IDD services to members
- Facilities such as residential treatment facilities
- Who does not need to be credentialed?
- Practitioners who provide care exclusively within the inpatient setting do not need to undergo the Trillium credentialing process and are not listed in the Trillium Provider Directory.
As part of Trillium’s credentialing process, each practitioner has the right:
- To email Credentialing@TrilliumNC.org for questions regarding the application process or to receive updates to a previously submitted application.
- To review information collected during the credentialing process except for references and National Practitioner Data Bank (NPDB).
- To be informed of the status of their credentialing application.
- To be notified of information that is significantly different than reported by the practitioner and to have the opportunity to correct erroneous information in writing.
- To be notified about the Credentialing Committee’s decision within ten (10) business days of the committee’s decision or Medical Director’s approval.