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Provider Digest | Volume 178

Date: 07/09/25

Upcoming Clinical Documentation Improvement Webinars

Trillium, Health Net and Wellcare providers are invited to join us for discussions that include an overview of risk adjustment and how it impacts you; tips to improve documentation and coding; and tips to stay compliant with regulatory requirements.

Webinars are open to providers, non-physician providers, coders, billers and administrative staff.  

To review the webinar schedule and sign up, please visit our websites:

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Trillium and Wellcare Announce Partnership with Healthmap Solutions for Kidney Health Management 

Trillium Community Health Plan (Trillium), Wellcare By Health Net (Wellcare), and Wellcare By Trillium Advantage (Wellcare) are partnering with Healthmap Solutions (Healthmap) to provide care coordination services within our kidney health management (KHM) program. As a leading national kidney health management company, the partnership with Healthmap will provide more comprehensive care for members with chronic kidney disease (CKD) stages 3, 4, 5, and end stage renal disease (ESRD).

If you have a patient with kidney disease, or chronic conditions that may lead to kidney disease, Healthmap may contact you to facilitate care. Healthmap provides collaborative recommendations through workflow-friendly clinical decision support.

Healthmap’s KHM program integrates into your existing practice workflow to complement your patient’s current plan of care. Healthmap can supply you with actionable information, based on industry proven best practices, and powered by data analytics, to more effectively anticipate and deliver the right clinical care.

We appreciate your ongoing care for our members. Be on the lookout for outreach from Trillium, Wellcare, and Healthmap for the introduction to our kidney health management (KHM) program. If you have any questions or concerns, please contact your assigned health plan Provider Engagement Administrator:

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Reminder: OHA Appointment Access Requirements for Trillium Medicaid Providers

To ensure access to care and improved health outcomes, Trillium Medicaid providers are contractually obligated to comply with the Oregon Health Authority access requirements. Please review the below access requirements and contact your dedicated Provider Engagement Representative if you have any questions.

OHA Appointment Access Requirements
Providers shall make Covered Services available 24 hours a day, seven (7) days a week. For after-hours care, Providers are to have an on-call physician/nurse or a messaging system advising members how to seek after-hours care.

All Providers are required to prioritize timely access for prioritized population members:

  • Pregnant women
  • Children ages birth through (5) years

Physical Health (Primary Care and Specialists) Appointment Access Standards
 Appointment Type & Access Standard

  • Emergency: Immediate or referred to an emergency department depending on the member’s condition
  • Urgent: Within 72 hours or as indicated in initial screening and in accordance with OAR 410-141-3840 (48 hours NCQA)
  • Well Care (Routine): Within 4 weeks, or as otherwise required by applicable care coordination rules including OAR 410-141-3860- 410-141-3870

Behavioral Health (Non-Specialty/Non-Priority Populations) Appointment Access Standards
 Appointment Type & Access Standard

  • Urgent Care: Within 24 hours
  • Routine Care: Assessment within seven (7) days of the request, with a second appointment occurring as clinically appropriate.

Specialty Behavioral Health (Priority Populations) Appointment Access Standards
Priority access order for entry per OAR 309-019-0135:

  1. Individuals who are pregnant and using substances intravenously
  2. Individuals who are pregnant
  3. Individuals who are using substances intravenously; and
  4. Individuals or families with dependent children.

* If a timeframe cannot be met due to lack of capacity, the member must be placed on a waitlist and provided interim services within 72 hours of being put on a waitlist. Interim services must be provided.

Appointment Type & Access Standard

  • Urgent Care: Within 24 hours
  • Opioid use disorder: Assessment and entry within 72 hours
  • Medication assisted treatment: As quickly as possible, not to exceed 72 hours for assessment and entry
  • IV drug users including heroin: Immediate assessment and entry. Admission for treatment in a residential level of care is required within fourteen (14) days of request, or, if interim series are necessary due to capacity restrictions, admission must commence within 120 days from placement on a waitlist
  • Children with serious emotional disturbance (as defined in OAR 410-141-3500): Any limits that the Authority may specify in the contract or in sub regulatory guidance
  • Pregnant women, veterans and their families, women with children, unpaid caregivers, families, and children ages birth through five years, individuals with HIV/AIDS or tuberculosis, individuals at the risk of first episode psychosis and the I/DD population: Immediate assessment and entry. If interim services are necessary due to capacity restrictions, treatment at appropriate level of care must commence within 120 days from placement on a waitlist

* For additional information, see OAR 410-141-3840, OAR 410-141-3860, OAR 410-141-3870, and OAR 309-019-0135.

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