PA Lookup
If you have questions about prior authorizations, please call:
Member and Recipient Service Line: 1-877-685-2415
Provider Support Service Line: 1-855-250-1539
Screening dark adaptation measurement (eg, rod recovery intercept time), with interpretation and report
How to Submit
N/A - No authorization is required
Unlisted ophthalmological service or procedure
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
Please submit your request to Trillium Health Resources
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
Authorization Guidelines
Prior approval (PA) is required prior to the start of all treatment services. The provider shall submit a request to the DHHS utilization review contractor to start the PA process. Detailed information and instructions for registering and submitting requests is available on the DHHS utilization review contractor's website: https://choicepa.medicaidprograms.org/Account/Login.aspx?ReturnUrl=%2f The PA request must clearly indicate that the service of a licensed therapist is required. For a beneficiary under age 21, the provider shall submit information supporting that all EPSDT criteria are met and evidence-based literature supporting the request, if available. A written evaluation report must be completed within three months of the requested treatment start date. When continued treatment is requested, an annual re-evaluation of the beneficiary’s status and performance must be documented in a written evaluation report. Each reauthorization request must document the efficacy of treatment. When granted, the approval is for medical approval only and does not guarantee payment or ensure beneficiary eligibility on the date of service. Retroactive PA is considered when Medicaid coverage is granted with a retroactive eligibility date after a beneficiary receives a service. Medicaid does not guarantee approval of retroactive PA requests.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual
Authorization Guidelines
The prior approval process is deemed met by the IEP, IFSP, IHP, BIP or 504 Plan processes.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
Authorization Guidelines
Prior approval (PA) is required prior to the start of all treatment services. The provider shall submit a request to the DHHS utilization review contractor to start the PA process. Detailed information and instructions for registering and submitting requests is available on the DHHS utilization review contractor's website: https://choicepa.medicaidprograms.org/Account/Login.aspx?ReturnUrl=%2f The PA request must clearly indicate that the service of a licensed therapist is required. For a beneficiary under age 21, the provider shall submit information supporting that all EPSDT criteria are met and evidence-based literature supporting the request, if available. A written evaluation report must be completed within three months of the requested treatment start date. When continued treatment is requested, an annual re-evaluation of the beneficiary’s status and performance must be documented in a written evaluation report. Each reauthorization request must document the efficacy of treatment. When granted, the approval is for medical approval only and does not guarantee payment or ensure beneficiary eligibility on the date of service. Retroactive PA is considered when Medicaid coverage is granted with a retroactive eligibility date after a beneficiary receives a service. Medicaid does not guarantee approval of retroactive PA requests.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals
Authorization Guidelines
The prior approval process is deemed met by the IEP, IFSP, IHP, BIP or 504 Plan processes.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Nasal function studies (eg, rhinomanometry)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Facial nerve function studies (eg, electroneuronography)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Laryngeal function studies (ie, aerodynamic testing and acoustic testing)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Evaluation of speech fluency (eg, stuttering, cluttering)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Evaluation of speech fluency (eg, stuttering, cluttering)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Behavioral and qualitative analysis of voice and resonance
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Behavioral and qualitative analysis of voice and resonance
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
How to Submit
N/A - No authorization is required
Resources
Treatment of swallowing dysfunction and/or oral function for feeding
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Treatment of swallowing dysfunction and/or oral function for feeding
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
Treatment of swallowing dysfunction and/or oral function for feeding
Authorization Guidelines
Please submit any records and any other information that you believe support the member has met the applicable medical necessity criteria to Trillium.
Conditional Requirements
Pre-authorization required for all providers unless rendered on same day as evaluation.
How to Submit
If applicable, please submit your request to Trillium.
If you find any wrong or out of date information on our pages, we want to know. Please email info@TrilliumNC.org with any corrections.