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
Full sole and heel wedge, between sole
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, counter, plastic reinforced
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, counter, leather reinforced
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, SACH cushion type
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, new leather, standard
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, new rubber, standard
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, Thomas with wedge
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, Thomas extended to ball
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, pad and depression for spur
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Heel, pad, removable for spur
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, insole, leather
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, insole, rubber
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, insole, felt covered with leather
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, sole, half
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, sole, full
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, toe tap, standard
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, toe tap, horseshoe
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, special extension to instep (leather with eyelets)
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, convert instep to Velcro closure
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
Orthopedic shoe addition, convert firm shoe counter to soft counter
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.
Reauthorization Guidelines
See the Carolina Complete Health site for specific requirements
Conditional Requirements
Pre-authorization is required for members 21 and older for all providers. For all other members, authorization is required for non-participating providers only.
How to Submit
If applicable, please submit your request to Carolina Complete Health.
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.