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Provider Digest | Volume 172

Date: 05/28/25

Trillium Medicaid, Health Net Commercial, Wellcare By Trillium Advantage Medicare, and Wellcare By Health Net Medicare Prior Authorization

Trillium Community Health Plan, Health Net Plan of Oregon, Inc., Wellcare By Trillium Advantage, and Wellcare By Health Net require prior authorization (PA) as a condition of payment for many services. 

We are committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. 

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.

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

Please view this notice (PDF) for prior authorization requirements effective January 1, 2025.

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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Community Feedback Requested: Oregon Perinatal Harm Reduction Toolkit

The University of Oregon and the Academy of Perinatal Harm Reduction have been working together to develop a toolkit for the state of Oregon. 
 
The draft Oregon Perinatal Harm Reduction Toolkit is intended to serve as a guide for pregnant people, their families, and providers to support them by offering information and resources on the systems and services that pregnant people encounter through a harm reductions lens, and specific to the state of Oregon.

We are ready for your feedback. If you have knowledge or experience with pregnancy and drug use, or you are a professional working in perinatal health care or harm reduction, please attend one or both of our virtual community feedback meetings hosted by the University of Oregon: 

  • Monday June 2, 1:00 - 2:00 p.m.: Legal and Health Systems
  • Wednesday June 11, 4:00 - 5:00 p.m.: Perinatal Health Care
  • View the flyer (PDF)
  • Use this link to register, and you will receive an email confirmation with Zoom links and a subsequent calendar invite.

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      Upcoming OPCA Webinars on Communication Training and 
      Providing Care to Patients Experiencing Intimate Partner Violence

      The Oregon Primary Care Association is hosting two new webinars in June. "Providing Care to Patients Experiencing Intimate Partner Violence: Universal Screening" discusses how patients currently experiencing violence may present in healthcare settings, and provides practical takeaways for working with the population. "Communication Training for Providers" explores practical strategies to deepen community understanding, navigate uncertainty, and build stronger, more inclusive connections with patients.

      Providing Care to Patients Experiencing Intimate Partner Violence: Universal Screening

      Communication Training for Providers

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      Wellcare By Health Net Medicare Prior Authorization Effective July 1, 2025

      Wellcare By Health Net requires prior authorization (PA) as a condition of payment for many services. 

      Wellcare By Health Net is committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice.

      It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.

      For complete CPT/HCPCS code listing, please see the Wellcare By Health Net Medicare Online Prior Authorization Tool on our website.

      Please view this notice (PDF) for changes to prior authorization requirements effective July 1, 2025,

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

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      Wellcare By Trillium Advantage Medicare Prior Authorization Effective July 1, 2025

      Wellcare By Trillium Advantage requires prior authorization (PA) as a condition of payment for many services. 

      Wellcare By Trillium Advantage is committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice.

      It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization. Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.

      For complete CPT/HCPCS code listing, please see the Wellcare By Trillium Advantage Medicare Online Prior Authorization Tool on our website.

      Please view this notice (PDF) for changes to prior authorization requirements effective July 1, 2025,

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

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      Active Tuberculosis Case Was Identified At Lane Middle School
      in SE Portland

      In May, Multnomah County public health officials confirmed one case of active pulmonary tuberculosis (TB) at Lane Middle School in Southeast Portland. A case investigation is underway, and may impact area clinicians.

      For more information and guidance regarding this situation, please view this Clinician Alert: Middle School Tuberculosis Exposure.

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      Pacific Power Accessibility Programs Toolkit

      Pacific Power has produced a new Accessibility Programs Toolkit (PDF) which includes resources in English and Spanish on emergency preparedness, planning for medical needs and backup power, and paying utility bills.
       
      The toolkit also has two new resources for customers who have a disability, rely on medical equipment, need help paying their bill, or prefer to receive information in a language other than English.

      • A new Accessibility webpage is a one-stop-shop to help customers easily navigate among available programs.
      • A new Customer Programs Flyer lists types of customer programs, includes a QR code for the Accessibility webpage, and invites customers to talk with a real person by calling our friendly customer service team.

      Please share this toolkit with anyone who may benefit from these programs. If you have any questions, please email wildfiresafety@pacificorp.com.

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