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Provider Digest | Volume 181

Date: 07/30/25

Wellsky Open Office Hours for Wellcare PAC Providers

Wellcare's partnership with tango | WellSky for delegated skilled home health and PAC facility management services went into effect July 1, 2025 for Wellcare By Health Net (Wellcare) and Wellcare By Trillium Advantage (Wellcare) members.

To support Wellcare providers (Acute, Long Term Acute Care Hospital, Skilled Nursing Facility and Inpatient Rehabilitation Facilities), we are hosting live virtual office hours to assist with:

  • Provider Portal Access & Troubleshooting
  • Live Resolution of Login Issues
  • Escalation Support
  • Introductions to Your In-Market Liaison

These sessions are an opportunity to resolve issues in real time, ensuring your team is equipped to use the provider portal effectively, and streamline communication with WellSky’s PAC Advance program.

Live office hours are scheduled:

  • Tuesday-Thursday, 8:30 a.m.-10:30 a.m. through August 14, 2025

To attend a session, please send your best contact email to Cheryl.babo@wellsky.com to receive an invite to office hours.

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

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Reminder: Complete the 2025 Annual Provider Satisfaction Survey

We want to know what's important to our Trillium, Health Net and Wellcare providers!

If you received the 2025 Annual Provider Satisfaction Survey from our vendor partner Qualtrics via mail or email, please complete it no later than August 7, 2025. Your feedback plays a vital role in helping us understand what’s working well and where we can improve to better support you.

Thank you for your time and partnership. If you have any questions about the survey or any aspect of your business with us, please contact your assigned Provider Engagement Administrator:

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Listening Sessions: OHP Interpreter Scheduling Portal

The Oregon Health Authority (OHA) is developing a new statewide Health Care Interpreter (HCI) Scheduling Portal to help providers schedule Oregon-credentialed interpreters for Oregon Health Plan (OHP) members with limited English proficiency or who are Deaf or hard of hearing.

To ensure this tool meets your needs, OHA is hosting community input sessions across Oregon. To learn more and provide your feedback, please register for one of the events below:

Provider Clinic Staff Sessions

Portland Metro Area Eastside

Portland Metro Area Westside

View the Portland Area Provider Clinic Staff Listening Sessions flyer (PDF) for more details.

Lane County

View the Lane County Provider Clinic Staff Listening Sessions flyer (PDF) for more details.

Health Care Interpreter Sessions

Portland Metro Area Eastside

Portland Metro Area Westside

View the Portland Area Health Care Interpreter Listening Sessions flyer (PDF) for more details.

Lane County

 View the Lane County Health Care Interpreter Staff Sessions flyer (PDF) for more details.

If you have questions about these events, please reach out to sean.snyder@oha.oregon.gov.

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Effective October 1, 2025: Wellcare Prior Authorization for Skin Substitutes & Wound Dressing

Wellcare By Trillium Advantage (Wellcare) and Wellcare By Health Net (Wellcare) 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. 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.

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

Please view this notice for changes to prior authorization requirements for skin substitutes and wound dressing effective October 1, 2025.

Thank you for your partnership in helping our members stay healthy.

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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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