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Provider Digest | Volume 113

Date: 02/21/24

New Process: Online Provider Portal Prior Authorizations

Many of our providers have shared feedback suggesting an improvement to the process for submitting prior authorization (PA) requests through the online provider portals. We heard you and we're excited to announce an enhancement to the online PA process! To make it easier for you to submit and manage PA requests, we recently launched this new process:

When you submit prior authorizations through the online Provider Portal, you will receive two numbers.

  • First you will receive an 8-digit tracking number for your PA submission.
  • Once your PA is under review, you will receive the IP/OP number which you can use for billing.

If you have any questions or if you have suggestions for how we can best support you, please contact your assigned health plan Provider Engagement Representative.

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

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New Payment Integrity Policies for Wellcare and Health Net Providers

Thank you for your continued partnership with Wellcare and Health Net Health Plan of Oregon, Inc. (Health Net). As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of new policies Wellcare and Health Net will be implementing effective on or after 5/24/2024.

Please view this Payment Integrity Policy notice (PDF) for information about the new policies.

Thank you for your continued participation and cooperation in our ongoing efforts to render quality healthcare to our members.

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Prepayment Claim Auditing Update for Trillium and Wellcare Providers

Thank you for your continued partnership with Wellcare and Trillium Community Health Plan (Trillium). As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities.

As a reminder, we have partnered with Optum who is supporting us in performing prepayment claim auditing. The purpose of our review is to verify the extent and nature of the services rendered for the patient’s condition and that the claim is coded correctly for the services billed.

For claims received on or after 5/24/2024, providers may experience a slight increase in written requests for medical record submission prior to payment based on the areas outlined below. These requests will come from Optum and will contain instructions for providing the documentation. Should the requested documents not be returned, the claim(s) will be denied. Providers will have the ability to dispute findings through Optum directly in the event of a disagreement.

Please view this Prepayment Claim Auditing notice (PDF) for information about Optum's prepayment claim auditing.

Thank you for your continued participation and cooperation in our ongoing efforts to render quality healthcare to our members.

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Responses Due July 15, 2024: Trillium Medicaid Bi-Annual Capacity Review

Have you completed the Trillium Provider Capacity Survey yet?

Oregon Health Authority (OHA) requires Trillium to report in-network provider capacity on a bi-annual basis to ensure members in our communities have access to high-quality healthcare. The survey is only four questions and takes  approximately 2 minutes to complete.

Please take the survey by July 15, 2024.

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

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Oregon ECHO Network Spring 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. You can now register for their spring programs on a wide range of topics, including gender affirming care, diabetes care, substance use disorder care, reproductive health, dementia, and more.

To learn more and register:

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Clinical Documentation Improvement (CDI) Webinars

Trillium, Health Net and Wellcare invite providers to attend upcoming CDI webinars. Each webinar includes an overview of Risk Adjustment (RA) and Hierarchical Condition Categories (HCCs).

Common HCC Coding Errors in Risk Adjustment

How to improve Risk Adjustment Coding Accuracy

Commonly Missed and Miscoded Diagnosis Codes

Compliant HCC Coding – What you need to know

HCC Coding for Risk Adjustment

For a complete list of webinars, please visit our websites:

Thank you for your partnership!

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Trillium 101: Access to Care Sessions

Would you like to learn more about Trillium Community Health Plan and how we can collaborate with you to improve the health of our Medicaid members and local communities? Please join us for “Trillium 101: Access to Care.” Facilitated by Kristinia Rogers, Senior Traditional Health Worker Liaison, and Dori Sumstad, Traditional Health Worker Liaison, this interactive session for providers and community partners explores a variety of topics about our organization’s programs and services, including:

  • CCO Service Regions
  • Interpreter Services
  • Case Management Program and Services
  • Behavioral Health
  • Traditional Health Workers
  • Dental Care
  • Non-Emergent Medical Transportation (NEMT)
  • And much more!

Sessions take place on the fourth Tuesday of every month, January-June, from 11:30 a.m.-12:30 p.m.

Register for Trillium 101

If you need accommodations or would like to schedule an individual session for your team/organization, please contact THW@TrilliumCHP.com

View the Trillium 101 Flyer (PDF) for more information.

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