Contracting with Trillium
Trillium partners with practitioners and provider agencies to build community well-being through the delivery of person-centered services and supports. This is accomplished by Trillium and the provider entering into a contractual agreement for the provision of services. The two main types of contract agreements include the Procurement Contract and the Out-of-Network Single Case Agreement.
Trillium operates an open network and accepts providers who meet objective quality standards and accept Network rates, except for certain services as set forth in N.C. Gen Stat 108D 23(c).
For Physical Health services including LTSS, DME, Occupational, Physical, and Speech Therapy, Trillium will enter into a good faith contracting effort with any willing provider of physical health services through our partnership with Carolina Complete Health. Please complete our Tailored Plan contract request form. You can also reach out directly to Carolina Complete Health by emailing networkrelations@cch-network.com, or calling 1-833-552-3876 (after choosing Provider Services, press 8 for Contracting).
For Behavioral Health, Substance Use, and Intellectual and Development Disability services, please submit request to join the network by emailing NetworkServicesSupport@TrilliumNC.org. Trillium is not accepting applications to expand closed network services outside of a formal recruitment. Closed network services open for recruitment due to network gaps are published on our Current Service Needs webpage. For a list of closed network services, please review N.C. Gen Stat 108D 23(c) for additional information.
Trillium requires all providers to be enrolled in NC Tracks and credentialed to provide services to Medicaid beneficiaries. Trillium utilizes the Provider Enrollment File and/or the NC Tracks Operations Portal to validate enrollment and credentialing. The North Carolina Department of Health and Human Services (the Department), through NCTracks, will continue to collect information and verify credentials for all providers currently enrolled or seeking to enroll in North Carolina’s Medicaid and/or Health Choice programs or as a State-funded service provider.
Tailored Plan Procurement Contract
Trillium began issuing the NC Department of Health and Human Services approved Tailored Plan Procurement Contract (“TP Provider Contract”) to their fully contracted providers in June 2022.
To learn more and review the Tailored Plan Provider Contract Template visit the Medicaid Transformation Information for providers.
An Out-of-Network Single Case Agreement (OON SCA) is an agreement between Trillium and a provider agency or practitioner who has not contracted with Trillium but wishes to request an agreement to provide services to a specific Trillium NC Medicaid member. OON SCAs are member-specific and require prior approval from Trillium for every member served by the provider. These OON SCAs cannot be backdated.
If the request meets Medical Necessity, it does not guarantee a provider will receive an OON SCA, authorization, or reimbursement. Also, please note that Trillium does not allow more than 2 members on an OON SCA. Before submitting the OON SCA Request Form at the bottom of the page, please check the following:
- Ensure the person you wish to serve is a Trillium NC Medicaid member needing behavioral health services and meets the requirements outlined in the service definition regarding age and diagnosis.
- Check the provider directory for an in-network provider who can perform this service for this member. The directory can be found here. In-Network Providers must be used if available.
- The Agency/Practice must:
- Be set up correctly in NCTracks to prevent encounter denials. This includes making sure the rendering and billing affiliations are correct, they have the required taxonomies to cover the service requested, the service address is listed as 003 or higher, and the Medicaid Health Plan is active.
- Have the appropriate facility license, accreditation, certification, and licensed staff to deliver the service as defined in the Clinical Coverage Policy;
- All required documentation must be submitted as attachments in the form. Utilization Management makes a determination for Medical Necessity based on the service code(s) and documentation submitted. Be sure to include all documentation required for each service requested based on the requirements outlined in the Benefit Plan found here. Note that not all services require review from UM for Medical Necessity. The Benefit Plan will indicate whether or not an authorization is required.&
- Be sure the requested service dates are not prior to the form submission.
- If you already have a Medicaid Direct/Tailored Plan contract with Trillium, you are considered In-Network, regardless of the site or service you wish to request. In-Network fully contracted Providers should not use the Out of Network Request Process or submit the Out of Network Request Form. In-Network Providers should contact Network Development via email at NetworkServicesSupport@TrilliumNC.org or at 1-855-250-1539 when a service or site addition is needed.
Below is the electronic form to submit your request for an OON SCA. We cannot grant you access to the SmartSheet due to PHI, so please retain your reference number to follow the submission updates in emails. If you have technical difficulties with this form, please reach out to OON@TrilliumNC.org.