ILOS Resources for Providers
Enhanced Care Management (ECM) services do not need prior authorization starting January 1, 2023.
What is ILOS?
ILOS (In Lieu of Services) is a multi-year initiative by the Oregon Health Authority (OHA) to improve the quality of life and health outcomes of Medicaid members through broad delivery system, program and payment reform across the Medicaid program.
This resource page has been developed to provide tools and resources to help providers easily navigate the ILOS program so they can better serve our members. On this page you will find the most current information – guides, forms, trainings and more – as well as the latest updates from our Plan. This page will be updated as new information and guidelines are available.
New to ILOS
Training & Webinars
General Information
Forms & Tools
FAQs
Communications
Data Collection
CLAIMS SUBMISSION
Trillium Community Health Plan requires that ILOS Programs for Lactation Consultations, Community Health Workers, Peer, and Qualified Mental Health Associate Recovery Support Services all offered in an Alternative setting providers submit fee-for-service professional claims on the paper CMS-1500 claim form, EDI 837 professional, or a Trillium invoice form.
Trillium prefers that all claims submitted electronically. Refer to electronic claims submission for more information.
- Claims/Invoice Submission Process
- Payor ID/Clearing House/EDI
PAPER CLAIM SUBMISSION
Medicaid/OHP
Trillium Community Health Plan
ATTN: CLAIMS DEPARTMENT
PO Box 5030
Farmington, MO 63640-5030
Coming Soon
ILOS does not require a prior authorization.
Connect Oregon is a coordinated care network consisting of healthcare, government, nonprofits, and others.
These network partners use Unite Us’ software to identify, deliver and pay for services that address the needs of individuals within their communities.
The platform increases visibility to ILOS providers, community partners, making it easy to use when referring member to ILOS providers and closing the loop on referrals.
Refer to the flyer for information on how to make Enhanced Care Management (ECM) referrals.
Joining the network is at no cost for community-based organizations. To join or for more information: https://uniteus.com/how-it-works/
Q: Do we need an authorization form for ILOS?
A. 1. You do not need authorization for ILOS; however, the member must agree with receiving the services in an alternative setting.
2. Member must be a Trillium Community Health Plan Member
3. You must be enrolled with Trillium Community Health Plan in providing ILOS.
Q: Does my organization need an NPI number
A. Yes, your organization will need an NPI number.
Q: Do you need a DMAP number to submit Invoices and/or Claims
A. Yes, you will need a DMAP number to be enrolled in ILOS to submit claims and/or invoices.
Q: Is an authorization needed to submit claims?
A. You do not need to have an authorization to submit claims, however you must be a contracted ILOS provider.
Q: Can a service that is below the (funding)line be provided as an ILOS?
A: A service may only be offered as ILOS if it meets the criteria of being a medically appropriate cost-effective substitute for a covered service or setting.
Q: How can ILOS reduce the administrative burden for community-based organizations (CBO’s)
A: ILOS will provide greater financial stability for CBO’s by enabling billing for substitute services offered to CCO members previously not available.
Q: If a member is using an ILOS transitions to a new CCO, does that service carry to the new CCO.
A: Not necessarily. Since each CCO may choose to offer different ILOS services, a particular service may not be available from all CCOs.
Q: Once a service is approved for one CCO does that make it approved for all CCO’s or require other CCOs to cover it?
A: An approved service may be utilized by any CCO, but there is no obligation for CCOs to add the approved services.
Q: Is a Certificate of Approval needed for ILOS for Peer Support and QMHA Services?
Certificate of Approval (COA) A Certificate of Approval (COA) is issued by the Oregon Health Authority to certify a provider’s ability to provide behavioral health treatment services pursuant to Oregon Secretary of State Administrative Rules OAR 309- 008-0100
A: ILOS organizational providers rendering Peer Services and/or QMHA are required to have a COA.
Q: Are CCOs (Coordinated Care Organization) required to have contracts with providers from community-based organizations offering ILOS? Is a CCO required to accept billing claims from any provider, even if they are out of network?
A: Yes, CCOs must hold contracts, whether that be a formal agreement, memorandum of understanding, etc., with CBOs or providers. ILOS should be thought of in the same way as covered services in the sense that a CCO wouldn’t have an individual member served by an out-of-network provider without an arrangement for that member. ILOS providers should be included in the provider directory to provide guidance to members.
Community Supports
23-315 – Community Supports Quick Reference Guide – English (PDF)
Please complete a form below as it pertains to the service and county(ies) you would like to provide service. Submit the completed form to the email address on the form. If you are interested in providing service in multiple counties, select all applicable counties on the form (only one form is needed).