Effective May 1, 2024: New Prior Authorization Requirements

Date: 03/01/24

Trillium Community Health Plan (Trillium), Health Net Health Plan of Oregon, Inc. (Health Net), Wellcare By Trillium Advantage (Wellcare), and Wellcare By Health Net (Wellcare) require prior authorization (PA) as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all commercial, Medicaid, and Medicare products offered.

We are committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.
It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.

For the complete CPT/HCPCS code listing, please see the Online Prior Authorization Tool on our websites at:

Wellcare By Trillium Advantage: Medicare Pre-Authorization Check
Wellcare By Health Net: Medicare Pre-Authorization Check
Health Net: Commercial Pre-Authorization Check
Trillium Community Health Plan: Medicaid Pre-Authorization Check

For new CMS codes effective October 1, 2023, please review this notification:

CMS New Code PA Notice (Trillium, Health Net and Wellcare) (PDF)

For prior authorization requirements effective May 1, 2024, please review these notifications:

Thank you for your partnership in helping our members stay healthy.