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Care Management for High-Risk Pregnancies (CMHRP) and Care Management for At-Risk Children (CMARC) programs will transition to NC Medicaid Standard Plans, Tailored Plans, and the Primary Care Case Management (PCCM) entity. Learn more here.

Trillium Tailored Plan Provider Resources

Effective October 1, 2026: Trillium Unified Claim System

What is Changing?

Effective October 1, 2026:

  • Claims for Trillium Tailored Plan members must be submitted directly to Trillium.
  • Many physical health prior authorizations will be submitted directly to Trillium.
  • Trillium will become the payer for Tailored Plan physical health claims.

What is Not Changing?

  • The services you provide to Trillium Tailored Plan members.
  • Your ability to continue serving Trillium Tailored Plan members.
  • Existing Carolina Complete Health agreements during the transition period.
  • NEMT claims (continue through Modivcare)
  • Vision claims (continue through Centene Vision)

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.

Through September 30, 2026Beginning October 1, 2026
Physical health claims submitted through Carolina Complete HealthPhysical health claims submitted directly to Trillium
Carolina Complete Health processes physical health claimsTrillium processes physical health claims
Physical health authorizations submitted to Carolina Complete HealthMany physical health authorizations submitted directly to Trillium*

Communications and Training About These Changes

Important

Even if you currently participate in the Trillium network through Carolina Complete Health, you must transition to submitting claims directly to Trillium beginning October 1, 2026. This requirement applies to nearly all participating providers. The only exceptions are NEMT and vision vendors.

Providers are encouraged to complete onboarding steps with Trillium by September 22 in anticipation of the October 1 launch. Start today!

Provider Relations Inquiries Post October 1, 2026

Please contact Trillium Health Resources at NetworkServicesSupport@TrilliumNC.org

Utilization Management 

*Some specialty-service authorizations will continue to be submitted to Carolina Complete Health or other partners.

Authorization PortalService
Carolina Complete Health
  • Durable Medical Equiment (DME), including orthodics, prosthetics, and hearing aid services.
  • PCS, Private Duty Nursing, Home Health, Hospice
  • Transplants and CAR-T-Cell therapy

Please Note: Beginning Oct. 1, 2026, the Trillium Physical Health Secure Portal will route providers to Availity Essentials for authorization submission. Create a free Availity account.

Centene Vision
  • Vision
EviCore
  • Genetic Testing
Evolent
  • Outpatient Imaging
  • Outpatient and Elective Inpatient Musculoskeletal Surgery and Interventional Pain Management
  • Radiation Oncology (Outpatient)
  • Note: For Rad Oncology, use the CarePro Provider Portal. For Advanced Imaging, MSK, and IPM utilize the RadMD Provider Portal
TurningPoint
  • Outpatient and Non-emergent Inpatient Interventional Cardiology Procedures
For authorizations managed by Carolina Complete Health. Providers also have the option to fax their authorization using the form below and to the applicable number outlined.

Additional Provider Resources

Provider Guides

Personal Care Services Request

  • 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.
Page Last Updated: 10/29/2026