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Provider Digest | Volume 163

Date: 03/26/25

Registration Open for Winter Spring ECHO Programs

The Oregon ECHO Network is an interactive educational and community-building experience that allows healthcare professionals throughout the state of Oregon to create a case-based learning environment through the convenience of video connection.

Registration is now open for Oregon ECHO Network programs that start in April 2025. Topics include:

Continuing education credits are available and each program is offered at no cost to you or your workplace. Visit the Oregon Echo Network website to learn more.

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PCP Member Assignments in Provider Portal

The Trillium, Health Net and Wellcare Provider Portal is experiencing an issue where member assignment is not reflecting accurately for some PCP providers. Our team is working diligently to resolve this issue. In the interim, while the legacy Provider Portal is being updated, providers can access accurate member assignment in our new Availity portal. To learn more about Availity, review the article in our January 22, 2024 Provider Digest. 

We will share the resolution timeline for accurate PCP member assignment in our legacy portal in next week's issue of the Provider Digest. In the meantime, please contact your dedicated Provider Engagement Representative if you need assistance with confirming member enrollment, gathering a current roster, or using the Availity portal:

We sincerely apologize for any inconvenience and thank you for your patience. Again, if you have any questions, please don't hesitate to contact your dedicated Provider Engagement Representative.

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Effective July 1, 2025, Wellcare Partners with tango and WellSky for Skilled Home Health and Post-Acute Facility Management Services

Effective July 1, 2025, Wellcare By Health Net (Wellcare) and Wellcare By Trillium Advantage (Wellcare) will begin partnering with tango and WellSky to deliver comprehensive Skilled Home Health and Post-Acute Facility management services.

The tango – WellSky solution brings a first of its kind partnership to the market to use the leading technology and services capabilities of WellSky and the skilled home health enablement expertise of tango to deliver a fully integrated proactive post-acute care program that streamlines and coordinates a cohesive provider and member experience across the post-acute continuum.

The agreement signifies the appointment of tango – WellSky as the delegated manager for Wellcare's skilled home health and post-acute care benefits related to skilled nursing facilities, inpatient rehabilitation facilities, and long-term acute care hospitals. This expanded partnership is specific to Wellcare’s Medicare Advantage members.

The expanded partnership encompasses several key components that aim to enhance the quality and delivery of skilled home health and post-acute care for Wellcare’s members:

  1. Referral Coordination and Authorization Management for Post-Acute Facilities:
    • Efficient management of referrals, referral coordination, and authorizations.
  2. Network Development and Management for Skilled Home Health:
    • Developing, contracting, maintaining, and credentialing a robust network of skilled home health care providers.
  3. Claims Payment for Skilled Home Health:
    • Timely and accurate claims payment for the services provided for skilled home health.
  4. Wellcare will continue to directly contract and pay claims for Post-Acute Facilities

To learn more, please view the Update on Wellcare Skilled Home Health and Post-Acute Facility Network Services notification (PDF).

If you have any questions, please contact your assigned Wellcare Provider Engagement Representative:

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2025 Medicaid Behavioral Health Provider Directed Payment Attestation

Effective January 1, 2025, the Oregon Health Authority (OHA) implemented the annual attestation process required for qualified Behavioral Health providers for three behavioral health directed payments (DPs) within the CCO contracts that further the goals and priorities of the Medicaid program. All Trillium Medicaid Behavioral Health/Substance Abuse providers who submitted Tier 2 Primarily Medicaid OHA attestations in 2024 are required by OHA to resubmit 2025 attestations to CCOs in order to continue qualifying for Behavioral Health Directed Payment rate tier increases.

Important Note: Please carefully review the criteria for each category when completing your attestation form. OHA has updated the Directed Payment (DP) program and limited qualifying providers to those in the Primarily Medicaid, COD and CLS categories listed below: 

  1. Behavioral Health Primarily Medicaid Directed Payment: attestation to CCO required for this DP
  2. Integrated Co-Occurring Disorder (COD) Directed Payment: OHA approval required for this DP
  3. Culturally and Linguistically Specific Services (CLS) Directed Payment: OHA approval required for this DP

What steps do providers need to take? 

Who do I contact at Trillium if I have questions?
To find more information and resources, please visit Trillium's Behavioral Health webpage.

If you have any questions, please contact your assigned Health Plan Provider Engagement Administrator (PEA).You can locate your assigned PEA on our Trillium Regional Reps Contact webpage. 

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New Prior Authorization Codes for Trillium Effective July 1, 2025

Trillium Community Health Plan (Trillium) requires prior authorization (PA) as a condition of payment for many services. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable. It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.

For new prior authorization requirements effective July 1, 2025, please review this Medicaid PA Requirement Changes notification (PDF).

For the complete CPT/HCPCS code listing, please see the Online Prior Authorization Tool on our websites at:

Thank you for your partnership in helping our members stay healthy. If you have any questions, please contact your assigned health plan Provider Engagement Representative:

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Take the Survey: Lane County's Community Mental Health Program

Lane County’s Community Mental Health Program (CMHP) is working to identify a more precise understanding of the current and anticipated workforce needs in our local behavioral health landscape.

Our goals are to:

  1. Inform schools on workforce pipeline development needs;
  2. Identify a data set of true recruitment needs for outpatient Behavioral Health;
  3. Inform future CCO and CMHP Behavioral Health strategic plans; and
  4. Identify regionally-specific impacts and needs for statewide workforce investments.

Please take a moment to support our efforts by completing this survey at your earliest convenience. We look forward to sharing our findings with those that participate in this survey, in service to our broader community.

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    Lane County Vaccine Workshop

    Lane County Public Health is hosting a vaccine workshop to increase provider confidence and expand skills to promote safe and timely vaccine administration in Lane County, especially in the pediatric population.

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      Trillium Behavioral Health:
      New Public Webpage Tracking Openings in Lane County

      Lane County Trillium Behavioral Health is excited to announce a new system to track behavioral health openings that is available to the public.
       
      The Lane County Trillium Behavioral Health team is in the final stages of creating a public webpage that will track openings for behavioral health services in Lane County. The webpage will go live in May.

      • If you offer behavioral health services in Lane County, we will be in touch with you via email throughout March and April about what this transition means for you.
      • We will join provider meetings during the next couple months to answer questions and help troubleshoot.
      • We plan to send out a link to the setup survey in late March/early April. This one-time survey will gather details about your practice that will be available for the public to access through the webpage.
      • We plan to transition to our new monthly availability survey in May. This survey will be similar to the monthly survey you fill out now, but will come via an automated email with a survey link specific to your practice. When you fill out the survey, the information you provide will automatically update your practice’s availability listed on the webpage.

      We appreciate your patience and anticipate that this will be an easier system in the long run. We will reach out soon and look forward to showing you what we’ve been working on. Thank you for your continued partnership!

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