Trillium Tailored Plan Provider Resources
Important Update: Trillium Physical Health Contracting and Claims Transition
Carolina Complete Health Network and Trillium Health Resources are partnering to share important updates regarding upcoming changes to Trillium Tailored Plan physical health services, contracting, authorizations and claims submission processes.These changes are part of Trillium’s transition to directly managing its physical health provider network and implementing a unified claims platform.
What is Changing
Effective October 1, 2026:
- Trillium will transition to a unified claims system for Tailored Plan operations
- All claims (physical health, behavioral health, and LTSS) for Trillium Tailored Plan members must be submitted directly to Trillium through a single portal
- Providers will no longer submit physical health claims to Carolina Complete Health for Trillium Tailored Plan members
- Some physical health authorizations must be submitted to Trillium through the new unified claims system portal. Some authorizations for specialty services will continue to be sent to Carolina Complete Health or other partners.
Important:
This change applies to all providers serving Trillium Tailored Plan members, including those currently contracted with Carolina Complete Health. The only exceptions are NEMT and vision vendors. These claims will continue being processed by ModivCare and Centene Vision, respectively.
Current vs. Future State (At a Glance)
Today
- Carolina Complete Health processes physical health claims for Trillium Tailored Plan members.
- Carolina Complete Health processes authorizations for many physical health services. Evolent processes authorizations for radiology, MSK surgeries, integrated pain management, and radiation oncology.
Beginning October 1, 2026
- All claims must be submitted to Trillium’s unified claims platform and will be processed by Trillium.
- Authorization for certain physical health services must be submitted to Trillium’s unified platform and will be processed by Trillium.
NOTE: While the services you provide will not change, the claims submission process will change.
Contracting and Network Transition
Trillium is moving to directly manage its physical health provider network, while continuing its partnership with Carolina Complete Health during the transition.
- Providers may receive outreach from Clearlink Partners, Trillium’s partner for physical health contracting.
- If a provider does not complete contracting:
- You may continue under your existing CCH agreement
- Trillium will act as the payer for claims
Today, Trillium leverages the Carolina Complete Health physical health network and claims infrastructure, and this transition reflects a shift toward Trillium building and managing its own network and claims operations.
What This Means for Providers
- On October 1, all providers must transition to submitting claims to Trillium for Tailored Plan members. Trillium will process claims as the single payer for Tailored Plan services.
- Physical Health providers contracted with Trillium through Carolina Complete Health are not exempt. This change impacts all participating providers (with limited exceptions such as NEMT and vision vendors).
- NEMT and vision claims will continue to be processed by Modivcare and Centene Vision, respectively.
- Providers may receive outreach from Clearlink Partners, Trillium’s partner for physical health contracting.
- On October 1, providers must transition to submitting authorizations for some physical health services to Trillium.
Why This Change is Occurring
The transition to a unified claims platform and direct contracting model is intended to:
- Streamline billing and administrative processes
- Enhance consistency and efficiency in claims processing
What You Should Do Now
To prepare for these changes:
- Attend the Trillium Physical Health Information Session on June 23 or July 28 to learn more about the claim submission changes. Register
- Watch for outreach regarding Trillium contracting (via Clearlink Partners)
- Monitor communications for training opportunities and additional guidance
Additional Resources
- Trillium Physical Health Contracting Information
- Trillium Provider Network Transition Q&A
- CCH Trillium Tailored Plan Resources
We Are Here to Support You
Carolina Complete Health and Trillium Health Resources are working collaboratively to ensure a smooth transition with no disruption to provider operations or member care.
Additional details, including training and FAQs, will be shared in the coming months.
Key Takeaway
Even if you are contracted with Trillium through Carolina Complete Health today, you must transition to submitting claims to Trillium for Trillium Tailored Plan members on October 1, 2026.
Communications
Carolina Complete Health & Trillium Health Resources: Provider Update
Contact Us and Resources
- Trillium Provider Support Service Line: 1-855-250-1539
- Trillium Member & Recipient Services: 1-877-685-2415
- Trillium Behavioral Health Crisis: 1-888-302-0738
- Carolina Complete Health Network Provider Engagement Team
- Tailored Plan Information for Trillium Providers
Training and Resources
For upcoming and archived live provider trainings, visit our Education and Training page.
Provider Portal
Trillium Physical Health Portal Setup:
- To access the Trillium Physical Health Portal, contracted providers must identify an individual who will serve as the Portal Account Manager.
- The Account Manager should follow the prompts using the portal link to create an account, validate their email, and register the Tax ID Number (TIN)
- After registering, email your assigned Provider Engagement Administrator email ProviderEngagement@cch-network.com to request verification of your portal registration request and assignment as Portal Account Manager.
Trillium Physical Health Portal Link
Provider Forms
- For Trillium Tailored Plan members, please complete the DHB 3051 Form: when making a referral for a PCS assessment or reassessment. Form can be emailed to LTSS@trilliumnc.org using the “Submit” button on the form, or by saving to your desktop and emailing as an attachment.
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)
- Payspan is an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs), also known as 835s.
- By using Payspan, you can speed up the processing and payment of your claims.
- Payspan: A Faster, Easier Way to Get Paid (PDF)
- To contact Payspan: Call 1-877-331-7154, Option 1 – Monday thru Friday 8:00 am to 8:00 pm est.
- Note: In November of 2022, Zelis, a company modernizing the business of healthcare, completed the acquisition of Payspan. Read on for more details. Providers should continue using the Payspan payment portal.
Claim Submission
Physical health claims for Trillium Tailored Plan members are processed by Carolina Complete Health.
View Trillium's Claim Submission Protocol under Claims/Finance Information & Forms
You can submit physical health claims in any of the following ways:
| Method | Claim Submission Instructions |
|---|---|
| Portal | Trillium Physical Health Portal |
| Trillium Health Resources PO Box 8003 Farmington, MO 63640-8003 | |
| Clearinghouse/EDI | Provider’s Clearinghouse connection to Availity for Claims processing. |
| Payer ID | 68069 |
Trillium Network Communication Bulletin #369
Trillium's hardship process supports our providers when they have reached a financial hardship status for various reasons. Trillium's process supports providers from start to finish through the process. A provider may claim a hardship payment via email communication to the Financial Hardship team at TrilliumFinance@TrilliumNC.org due to delays in claims processing or other operational concern.
Trillium Prior Auth Flexibilities
Trillium will initiate a no prior authorization required period for physical and behavioral health services to ensure Providers with contracts will be able to file claims for dates of service from July 1, 2024 through January 31, 2025 without authorization.
Pre-Auth Tool
To check on a specific physical health service or procedure for Trillium Tailored Plan members, use the Pre-Auth Tool. Providers should also review the Clinical Coverage Policy for specific details on services and procedures.
Trillium Physical Health Pre-Auth Tool
Authorization Submission
Physical health authorizations are reviewed by Carolina Complete Health. Please use one of the following methods to submit a physical health PA.
| Method | Physical Health PA Submission Instructions |
|---|---|
| Portal | Trillium Physical Health Portal |
| Fax | Use the Trillium PA Fax Form (PDF) and submit to one of the following:
|
| Phone | Call Trillium Provider Support Service Line at 855-250-1539 to be connected to the physical health utilization management team. |
Non-emergent, Advanced, Outpatient Imaging Services
- In an effort to continue promotion of quality improvement for services provided to Trillium members, effective July 1, 2024, Trillium will use Evolent, formerly known as National Imaging Associates, Inc. (NIA) to provide the management and prior authorization of non-emergent, advanced, outpatient imaging services.
- Services managed and authorized by NIA include outpatient:
- CT/CTA
- CCTA
- MRI/MRA
- PET Scan
- MUGA Scan
- Myocardial Perfusion Imaging (MPI)
- Stress Echocardiography
- Echocardiography
- Please visit Evolent's website for Trillium Health Resources to download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Website to obtain and check authorizations