Prior Authorization Services Instructions
Prior Authorization at a Glance
Prior Authorization is NOT Required
- Services rendered in an emergency room or urgent care center
- Services rendered by a public health or welfare agency
- Family planning services billed with a contraceptive management diagnosis
Prior Authorization or Notification IS Required
- Admission of a member to an inpatient facility
- Service requests that are over the benefit limit or a non-covered code
Notice: Flexibilities
Trillium will implement Flexibilities beginning October 1, 2026, through January 4, 2027. During this period, no prior authorization will be required for outpatient specialized services, including:
- Physical Therapy
- Occupational Therapy
- Speech Therapy
- Audiology Therapy
These flexibilities are intended to support continuity of care during the transition period and ensure members can access necessary services without interruption.
Prior Authorization Tool
To check on a specific service or procedure, use one of the Prior Authorization (PA) Tools linked below.
Trillium Prior Authorization (PA) Lookup Tool
To check on a specific service or procedure for Trillium members, use this Prior Authorization Tool. Providers should also review the Clinical Coverage Policy for specific details on services and procedures.
This tool lets providers and members know which services or treatments require permission from Trillium before care can be provided.
How to Submit a Prior Authorization
Trillium encourages prior authorization requests to be submitted through the appropriate electronic portal.
Prior Authorization Portals
| Authorization Portal | Service |
|---|---|
| Trillium iTransact Portal |
|
| Trillium Provider Direct Portal |
|
| Carolina Complete Health-Availity-Availity |
|
| Centene Vision |
|
| EviCore |
|
| Evolent (RadMD) |
|
| Evolent (CarePro) |
|
| Turning Point |
|
For more detailed information, see our Authorization Submission Guidelines