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Provider Digest | Volume 86

Date: 06/28/23

Trillium Behavioral Health Provider Credentialing Update for July 1, 2023 

What is changing  

As of July 1, 2023, Trillium Community Health Plan (Trillium) will add Behavioral Health (BH) Board Registered Associates to the BH provider types that the CCO can enroll as a part of credentialing for BH group practices. 

As a CCO and partner with our BH provider network, Trillium values a whole-person approach to overall wellness and access to healthcare services for our members. That includes working with our BH provider network on strategies that support the best access to high quality and effective BH treatment services. In collaboration with our BH provider partners, we received feedback that adding BH associates registered with state clinical boards as allowed under the 410 OARs will enable improved access to BH services and support building the BH workforce of clinicians that serve Oregon Health Plan (OHP) members across our CCO regions. 

What is remaining the same

The following BH practitioner types require the below state clinical board license or OHA certification:

  • Credentialing Independent BH Practitioners: Individual BH practitioner credentialing requires an active license in good standing with a state clinical board in OR to practice independently without supervision.
  • Credentialing BH Practitioners certified through the Mental Health and Addictions Certification Board of Oregon (MHACBO): QMHPs, QMHAs, CADCs, CGACs and other BH practitioner types allowable under the 309 OARs require a provider/agency to hold a COA with OHA in order to enroll and credential these BH practitioner types. 

Where to send questions or updates to your Trillium BH roster template  

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Responses Due 8/15/23: Trillium Medicaid Bi-Annual Capacity Review

Have you completed the Trillium Provider Capacity Survey yet?

Oregon Health Authority (OHA) requires Trillium to report in-network provider capacity on a bi-annual basis to ensure members in our communities have access to high-quality healthcare. The survey is only four questions and takes  approximately 2 minutes to complete.

Please take the survey by August 15, 2023.

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

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New Payment Integrity Edit Effective September 30, 2023

Thank you for your continued partnership with Trillium Community Health Plan, Wellcare By Trillium Advantage, and Wellcare By Health Net. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. As a reminder, we have partnered with Optum who is supporting us in performing prepayment claim auditing. The purpose of our review is to verify the extent and nature of the services rendered for the patient’s condition and that the claim is coded correctly for the services billed.

For claims received on or after 9/30/2023, providers may experience a slight increase in written requests for medical record submission prior to payment based on the areas outlined in this document (PDF). These requests will come from Optum and will contain instructions for providing the documentation. Should the requested documents not be returned, the claim(s) will be denied. Providers will have the ability to dispute findings through Optum directly in the event of a disagreement.

Thank you for your continued participation and cooperation in our ongoing efforts to help you provide quality health care to our members.

View the full notice (PDF)

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New Payment Integrity Changes & Initiative Effective September 30, 2023

Thank you for your continued partnership with Trillium Community Health Plan, Wellcare By Trillium Advantage, and Wellcare By Health Net. As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of changes to existing review criteria and one new initiative that will go into place on or after 9/30/2023. You can view the changes and new initiative in this document (PDF).

Thank you for your continued participation and cooperation in our ongoing efforts to help you provide quality health care to our members.

View the full notice (PDF)

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People of Any Age or Immigration Status May Qualify for Full Oregon Health Plan (OHP) Benefits Effective July 1, 2023

Through the Healthier Oregon program, as of July 1, 2023, people of all ages who meet income and other criteria qualify for full OHP benefits and other services and supports, no matter their immigration status. This includes individuals between the ages of 26-54 with emergency coverage (Citizenship Waived Medical [CWM]). CWM members currently enrolled through the Marketplace (HealthCare.gov) need to report their new full OHP benefits to the Marketplace after they receive their eligibility notice.

For more information about the Healthier Oregon program, including FAQs and an Outreach Toolkit (PDF), visit the OHA website.

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Trillium Community Benefit Initiatives Small Grant RFA

Trillium is excited to announce our Request for Applications (RFA) for 2023 Small Grants for Community Benefit Initiatives. 

All grant funding is designed to support projects that drive healthcare quality solutions to improve the social determinants of health in Trillium’s service areas. Proposed community-level interventions may support both Trillium Oregon Health Plan members and members of the larger community, and are focused on improving health outcomes, alleviating health disparities, and advancing health equity.

Organizations serving Lane, Western Douglas (Reedsport), Western Linn (Harrisburg), Multnomah, Clackamas, and Washington counties are invited to apply. Organizations are encouraged to consider submitting joint applications for funding of projects with broad community impact and collaboration.

You will also find this information and application materials on the Trillium website. 

If you have any questions, please email: TCH_OpsAdministration@TrilliumCHP.com

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