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Provider Digest | Volume 100

Date: 11/01/23

Effective 2/1/24: New Musculoskeletal Management Program with National Imaging Associates

Trillium Community Health Plan (Trillium), Health Net Plan of Oregon, Inc. (Health Net), Wellcare By Trillium Advantage (Wellcare), and Wellcare By Health Net (Wellcare) are committed to continuous improvement of quality services for our members. With that in mind, Trillium, Health Net, and Wellcare have expanded our partnership with National Imaging Associates, Inc. (NIA) to implement a Musculoskeletal (MSK) Management program.

The MSK program will include prior authorizations for non-emergent inpatient and outpatient hip, knee, shoulder, lumbar, and cervical spine surgeries for Trillium, Health Net, and Wellcare members. Our current MSK program and utilization management efforts with TurningPoint will be terminated as of January 31, 2024.

Under the terms of the agreement between Trillium, Health Net, Wellcare, and NIA:

  • Trillium, Health Net, and Wellcare will oversee the MSK program and continue to be responsible for claims adjudication and medical policies.
  • NIA will manage inpatient and outpatient MSK surgeries through the existing contractual relationships with Trillium, Health Net and Wellcare.

We are planning for a February 1, 2024, implementation. For more information, please review this NIA MSK Announcement Notice (PDF).

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

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Effective 11/1/23: New Prior Authorization Timelines for Trillium Medicaid Behavioral Health SUD Providers

Trillium Community Health Plan is committed to partnering with you to make SUD services accessible and available for TCHP members.

Effective Wednesday, November 1, 2023, Trillium has updated its prior authorization timelines for Behavioral Health Substance Use Disorder (SUD) residential providers as detailed below:

Update #1:

  • Providers: Trillium Medicaid-contracted providers offering SUD Residential 3.5 ASAM level of care
  • Prior Authorization (PA) Timelines for 3.5 SUD Residential
    • Initial PA: up to 30 days with Medical Necessity
    • Concurrent PA: up to 30 days with Medical Necessity
  • Effective Date: 11/1/23

Update #2:

  • Providers: Trillium Medicaid-contracted providers offering SUD 3.7R (Residential) ASAM level of care
  • Prior Authorization (PA) Timelines for 3.7R SUD Residential
    • Initial PA: up to 30 days with Medical Necessity
    • Concurrent PA: up to 7 days with Medical Necessity
  • Effective Date: 11/1/23

Thank you for your partnership in helping our members stay healthy. If you have any questions, please contact your assigned Provider Relations Representative.

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Early Childhood Social Emotional Health Community Conversation – Rural Lane County

If you have any questions, please contact Robert Phillips with Trillium Community Health Plan.

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Prescribing Parks: Enhancing Community Health Through Exceptional Parks

Trillium invites providers to join Eugene Parks Foundation, Lane Community Health Council and Lane County Medical Society for a night exploring the topic of "Preventive Health through Exceptional Parks." Guest speakers include Ashley Espinoza, Executive Director, Lane Workforce Partnership; Dr. Pilar Bradshaw, Owner, Journey Family Medicine; Dr. Patrick Leudtke, Senior Public Health Officer, Lane County; Todd Salnas, CEO, Slocum Center for Orthopedics and Sports Medicine; and Ariel Lissman, Executive Director, Eugene Parks Foundation.

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Medicare Annual Enrollment Period for Wellcare By Health Net & Wellcare By Trillium Advantage 

Medicare Annual Enrollment Period is here! You may receive calls from patients checking on which Medicare plans you accept.

Several years ago, we combined multiple brands under the Wellcare name to offer a better range of plans that provide members with affordable access to doctors, nurses, and specialists.

Health Net and Trillium Advantage are now Wellcare. As always, we are committed to working with you to ensure your patients receive the best care.

For a helpful reference guide, please download this list of Wellcare plan names and plan codes (PDF).

If you have any questions, please contact your assigned health plan Provider Relations Representative.

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Help Shape Health Equity in Healthcare! 

To help shape health equity in healthcare, please take the Provider Health Equity & Technology Survey today! Trillium is committed to partnering with you to support culturally competent care for our members.

We use your feedback to:

  • Identify areas of need in our network
  • Inform our community health equity initiatives
  • Develop provider resources to help improve access to care and health outcomes

Take the Provider Health Equity & Technology Survey – Your responses are due by December 31, 2023.

Thank you for your partnership in helping our members stay healthy. If you have any questions, please reach out to your Provider Relations Representative or call Provider Services at 1-877-600-5472.

Note: If you would like to gather the information before taking the online survey, please view the Provider Health Equity and Technology Survey (PDF).

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Regional 2024 Behavioral Health Directed Payment Provider Webinars

Trillium Community Health Plan and the Oregon Health Authority (OHA) invite you to a series of Regional 2024 Behavioral Health Directed Payment Provider Webinars. Based on provider feedback, we are offering sessions that will focus on regions and the applicable CCOs. 

These webinars will provide an update on the renewal of the Behavioral Health increases that went into effect in January 2023. This is typically called the Tier 1 and Tier 2 increases or 15% and 30% increases for the majority of behavioral health services. This also includes the Culturally and Linguistically Specific Services (CLSS) and Co-occurring disorder (COD) add-on payments.

Southwest Region

  • November 3, 1:30-3 p.m.
  • CCO Presenters: Advanced Health, AllCare CCO, Cascade Health Alliance, Jackson Care Connect, PacificSource Community Solutions, Trillium Community Health Plan, and Umpqua Health Alliance
  • Register for the November 3 Webinar

You will be able to ask questions at the end of the presentation. If you would like to submit questions in advance, please send them to Actuarial.Services@oha.oregon.gov.

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