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, and 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.

An Out-of-Network Single Case Agreement (OON SCA) is an agreement between Trillium and a provider agency or practitioner that has not contracted with Trillium; however has chosen to render services to an individual enrolled with Trillium. Single Case Agreements are member specific and require prior approval from Trillium for every member served.

NOTE: The Out-of-Network Single Case Agreement process is for provider agencies and practitioners that do not have a current contract with Trillium. Credentialed provider agencies and practitioners that have a current contract to be an In-Network Provider should contact Trillium Network Development to request additions to their contract. Network Development can be contacted using one of the following methods:

Email: NetworkServicesSupport@TrilliumNC.org or
Phone: 855-250-1539

Before Submitting an Out-Of-Network Single Case Agreement Request (OON SCA)

Before submitting an OON SCA request, a provider agency or practitioner must verify that Trillium covers the desired service(s) and confirm there is no In-Network Provider available to deliver the service(s).

For a complete list of covered services, review the Trillium Benefit Plan.
To confirm In-Network Provider availability, access the Trillium Provider Directory or contact the assigned Care Manager. If there is no Care Manager assigned, contact Trillium at 1-877-685-2415 for assistance in selecting an In-Network Provider.

If a provider agency or practitioner still requires an OON SCA, the following steps should be completed in the order detailed below. Any deviation will cause delays in the overall process.

STEP 1: Confirm NCTracks Enrollment

Every provider agency, practitioner, and supplemental delivering a service to a Medicaid eligible member or State-funded recipient, must be enrolled and active in NCTracks. Trillium will conduct a review of NCTracks enrollment prior to initiating the OON SCA process. Before submitting an OON SCA request, provider agencies and practitioners should confirm the following:

NCTracks enrollment;
Provider Status is “01-Active”;
Taxonomy Classification will adjudicate the service(s) requested;
The service address is found under Service Location as 003 or above (if applicable); and
The correct rendering provider affiliations are present (if applicable).

To review your information visit the NCTracks website .

STEP 2: NCTracks Verification and Establish Medical Necessity

During Step 2, the following will occur in this order:

The provider agency or practitioner will submit the required information outlined below.
Trillium will verify NCTracks enrollment.
Based on NCTracks enrollment findings:
1. No Issues found – Utilization Management (UM) will complete the Medical Necessity (MN) determination, notify the provider agency or practitioner of the decision, and provide instructions for submitting the OON Request form (when applicable).
2. Issues found – The OON SCA process will stop and Trillium will notify the provider agency or practitioner of NCTracks enrollment findings.

To initiate Step 2, the provider agency or practitioner must contact Utilization Management and provide the following information:

Required for NCTracks Verification:

Provider Name (as listed on a W-9)
Provider TaxID
Provider NPI
Provider Taxonomy
Service Address

Required for Medical Necessity Review:

Primary Contact at Provider Agency including phone number, email, etc.;
Members Name, Date of Birth (DOB), and Primary Diagnosis (ICD 10 Code);
Service(s) Requested (including the service code);
Number of Units Requested;
Service Start and End Date; and
Clinical Information to support Medical Necessity including but not limited to:
- Clinical support of service entrance criteria and/or Comprehensive Clinical Assessment
- Treatment Plan/PCP/ISP
- Service Order for the service being requested

Utilization Management can be contacted 1 of 3 ways:

Email: UM@TrilliumNC.org
Fax: 1-252-215-6875
Phone: 1-866-998-2597

STEP 3: Submit the OON Request Form & Documents

Provider agencies and practitioners should not begin Step 3 unless they have received confirmation of Medical Necessity from Utilization Management. Unsolicited OON SCA request forms will be returned as Unable to Process with instructions to contact Utilization Management. Provider agencies and practitioners are encouraged to review their information thoroughly. Incomplete request forms and missing documentation will cause delays in this process.

Request forms and documentation can be submitted using one of the following methods:

Email: OON@TrilliumNC.org
Fax: 252-215-6887
Mail: Trillium Health Resources, Attn: Contracts 201 W. First Street Greenville, NC 27858.

Required Forms and Documentation:

For the best results, please save the Adobe PDF form to a local drive on your computer before completing the form.

If you have any questions about the Out of Network Request Form or this process, please email your question to OON@TrilliumNC.org.

What Providers Need to Know

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 need for a specific member/recipient is identified.
The member meeting Medical Necessity does not guarantee a provider will receive an Out of Network Agreement, authorization, or reimbursement. To ensure a provider does not encounter delays or issues, they must:
1. Be set up correctly in NCTracks to prevent encounter denials. This includes making sure their rendering and billing affiliations are correct, they have the required taxonomies to cover the service requested, the service address listed as 003 or higher, and their Medicaid Benefit Plan is current;
2. Have the appropriate facility license, accreditation, certification, and licensed staff to deliver the service as defined in the Clinical Coverage Policy; and
3. Confirm that the member has Medicaid, is covered by Trillium, and meets the requirements outlined in the service definition regarding age and diagnosis.
Utilization Management makes a determination for Medical Necessity based on the service code(s) and documentation submitted to them. If the Out of Network Request form contains additional codes, they will not be included in the Agreement. Provider should ensure that all of the anticipated services are being submitted to UM when establishing Medical Necessity.
NC Tracks is the statewide multi-payer Medicaid Management Information System used by the N.C. Department of Health and Human Services (NC DHHS). All providers delivering services to members must enroll with NC Tracks. Additionally, all providers must have applicable licenses, accreditations, and registrations required for its facilities and staff while providing services to Trillium members.

Page last verified on March 07, 2025

Procurement Contract

Out-of-Network Single Case Agreement*

Required for NCTracks Verification:

Required for Medical Necessity Review:

Utilization Management can be contacted 1 of 3 ways:

Required Forms and Documentation:

What Providers Need to Know