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Provider Digest | Volume 184

Date: 08/20/25

Effective April 1, 2025: Prior Authorization Requirements for Trillium, Health Net & Wellcare

Trillium Community Health Plan (Trillium), Health Net Health Plan of Oregon, Inc. (Health Net), 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 effective April 1, 2025.

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

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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. In addition, there is a new on-demand Risk Adjustment Training for Providers available 24/7.

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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Health-Related Social Needs Referrals for Trillium Members

Providers interested in referring a member to Trillium for Health-Related Social Needs (HRSN) services can use the following closed-loop referrals process:

  • Providers can complete the ‘Assistance Request Form’ (ARF) found at the Unite Us website
  • Once an ‘Assistance Request Form’ (ARF) is submitted, Trillium staff will either begin working the case or will forward it to a contracted HRSN provider for service.

Trillium has partnered with Unite Us, also called Connect Oregon, to help members access HRSN benefits through closed-loop referrals. Through this platform, providers can:

  • Send HRSN requests as closed-loop referrals to Trillium
  • Receive referrals from Trillium to fulfill HRSN-contracted services
  • Submit invoices to Trillium for HRSN services provided to receive reimbursement
  • Support clients in submitting a self-referral to request HRSN services

If providers have any additional questions or needs, please reach out to hrsn@trilliumchp.com for assistance.

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Trillium Behavioral Health Provider Credentialing Update for July 1, 2025

** Update for Lane County Behavioral Health Providers effective August 22, 2025 **

What is changing
As of July 1, 2025, Trillium Community Health Plan (Trillium) changed our behavioral health (BH) provider credentialing process for unlicensed practitioners. This change is applicable for all unlicensed practitioners who are employed with BH providers, regardless of whether they hold a Certificate of Approval (COA) with Oregon Health Authority (OHA) for BH services or not. 

As a CCO and partner with our BH provider network, Trillium values a whole-person approach to overall wellness and access to healthcare services for our members. That includes our responsibility as a CCO to thoroughly vet practitioners employed by our provider network to ensure high quality, effective and safe BH treatment services.   

  • Currently, our process for credentialing unlicensed practitioners is not aligned with our standard process for licensed practitioners. This change will create a streamlined approach with a similar process for both licensed and unlicensed practitioners. 
  • Trillium will require unlicensed practitioners to submit an Oregon Practitioner Credentialing Application (OPCA) for all new credentialing requests and for recredentialing.
  • Trillium Lane County BH provider update: Friday, August 22 will be the last day Trillium Behavioral Health will process OPCA credentialing forms for unlicensed BH practitioners providing services in Lane County.  Beginning Monday, August 25, BH providers should submit all OPCA BH credentialing forms directly to Trillium Credentialing Department at Trillium Provider Operations.

What is remaining the same
There is no change to the existing credentialing or recredentialing process for the following BH practitioner types:

  • BH practitioners with an active license issued by Oregon state clinical board to practice independently. 
  • BH practitioners who work with a provider who is currently approved for delegated credentialing through Trillium. 

Where to send questions or Trillium CCO OPCA credentialing forms:

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