Provider Tailored Plan Contracting Reminders

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Please Note

The Department of Health and Human Services is delaying the implementation of the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans. Tailored Plan launch will be July 1, 2024.

If you are currently contracted with Trillium, please research and consider also contracting with at least one of the Standard Plan PHPs. After July 1, 2024, providers will no longer bill Trillium for services provided to members that transition from Trillium to a Standard Plan.

Tailored Plan Provider 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. During the beneficiary choice period ( for Tailored Plan Launch, beneficiaries can choose a Primary Care Provider (PCP) by contacting their Tailored Plan. Beneficiaries who do not make a choice will be automatically assigned a PCP.

Per NCDHHS, there is a 90-day Opt-Out period from when you receive the new Tailored Plan contract. 

Rejecting participation in any program shall not have any impact a provider’s ability to continue participation under other programs.

Please forward any questions regarding the TP Provider Contract or the contracting process to the Provider Support Services Line at 1-855-250-1539.

The new Tailored Plan Provider Manual has been posted on Provider Learning Campus and in Provider Direct. Those providers who have signed and executed a Tailored Plan contract can view the new manual now.

Please note: The Tailored Plan Provider Manual will not be in effect until the Tailored Plan launch. There will be a watermark on the new manual until that time.

Combined Medicaid and State Contract Template

General Terms and Conditions

 

Appendix F

Hospital Addendum

Appendix A

Federal Assurances Certification Regarding Environmental Tobacco Smoke

Appendix G

Business Associate Addendum

Appendix B

Federal Assurances Certification Regarding lobbying

Attachment A

Contracted Services and Approved Sites

Appendix C

Federal Assurances Certification Regarding Drug-free Workplace Requirements

Attachment B

Deficit Reduction Act

Appendix D

Federal Assurances Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions

Attachment C

Advanced Medical Home Program Policy for Medicaid and NC Health Choice Members

Appendix E

Outcomes and Reporting Requirements

Attachment D

Pregnancy Management Program Policy for Medicaid and NC Health Choice Members

Appendix F

Agency Addendum

Attachment E

Care Management for High-Risk Pregnancy Policy for Medicaid and NC Health Choice Members

Appendix F

Practitioner/Group Addendum

Attachment F

Care Management for At-Risk Children Policy for Medicaid and NC Health Choice Members

Appendix F

ICF Addendum

Attachment G

Indian Health Care Providers

Note: The contract template is subject to change as the Department issues additional guidance. Trillium will communicate such changes in a Trillium Network Communication Bulletin and incorporate the changes, when applicable, in an addendum. Additionally, while some of the languages can be negotiated, most of the revised language is required by the Department to be verbatim.

Trillium aims to develop a robust integrated network of providers and maintains an open network for all physical health providers. To join the Trillium network, for physical health services, please contact NetworkServicesSupport@TrilliumNC.org.

Trillium maintains a closed network for BH/IDD services. To request to join the Trillium network for BH/IDD services, please visit our Provider Recruitment or Vendor Opportunities webpage for current network openings OR email NetworkServicesSupport@TrilliumNC.org.

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