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, 2026 | Beginning October 1, 2026 |
|---|---|
| Physical health claims submitted through Carolina Complete Health | Physical health claims submitted directly to Trillium |
| Carolina Complete Health processes physical health claims | Trillium processes physical health claims |
| Physical health authorizations submitted to Carolina Complete Health | Many 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!
Utilization Management
*Some specialty-service authorizations will continue to be submitted to Carolina Complete Health or other partners.
| Authorization Portal | Service |
|---|---|
| Carolina Complete Health |
|
| Centene Vision |
|
| EviCore |
|
| Evolent |
|
| TurningPoint |
|
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.
Provider Resources: Current through September 30, 2026
- 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.
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.
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
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. |