Provider Digest | Volume 203
Date: 02/11/26
Prior Authorization Update: Lane County CCO Transition
Effective February 1, 2026, PacificSource Community Solutions (PacificSource) has ended its role as a coordinated care organization (CCO) in Lane County and Oregon Health Plan (OHP) members currently covered by PacificSource have moved to Trillium Community Health Plan (Trillium).
Trillium is committed to working with the Oregon Health Authority (OHA), PacificSource, providers, and community-based organizations to ensure a smooth transition for new members transitioning to our health plan. We appreciate your partnership and your patience during this transition.
Below is some information to help support you and your former PacificSource members who have joined Trillium:
Transition of Care Period
| Members with Medicaid/OHP | Members with Medicaid & Medicare | Members with Specialty Coverage: Care for High-Risk Conditions |
|---|---|---|
| Physical Health: 30 days | Physical Health: 90 days |
|
| Dental: 30 days | Dental: 90 days | |
| Behavioral Health: 60 days | Behavioral Health: 90 days |
Transition of Care Period
During the transition of care period, new Trillium members can keep getting approved services from their previous providers. This is usually 30, 60, or 90 days depending on healthcare needs and the type of care:
Prior Authorizations for Previously Approved Care
PacificSource has transferred prior authorizations (PAs) for previously approved care to Trillium. However, some of these PAs are not yet appearing in the Provider Portals. We are actively engaged in getting the Portals updated as quickly as possible.
Please note:
- If you had already submitted a PA to PacificSource and it was approved, please do not submit a duplicate PA to Trilllium for that same service.
- Please continue to see new Trillium members. Do not cancel appointments and previously scheduled surgeries.
Trillium Prior Authorization Requirements
Some services that previously did not require prior authorization may now require one under Trillium’s policies. Similarly, some services that did require prior authorization for PacificSource may not require one for Trillium. You can view Trillium's prior authorization requirements on our OHP Pre-Auth webpage.
Temporary Manual Review (February 1–10, 2026):
Trillium will apply a manual review during this period. Any claim for a transitioning member that would otherwise deny due to “no authorization on file” will undergo manual review.
Continue submitting prior authorizations as required:
Providers should continue to follow Trillium’s standard prior authorization requirements. This does not waive prior authorization rules—it simply prevents care disruption while authorizations are obtained.
Additional Resources
- Trillium website: Lane County CCO Transition webpage
- Trillium video: Lane County CCO Transition Provider Listening Session
Thank you again for your partnership in helping our members stay healthy. If you have any questions, please contact Trillium's Provider Engagement Team.
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Song for Charlie Provider Toolkit: Protecting Young Patients from Fake Prescription Drugs
Trillium is proud to partner with Song for Charlie to help address Oregon’s epidemic of youth fentanyl overdose deaths through a series of prevention, outreach and engagement efforts including this new resource for providers: Provider Toolkit: Protecting Young Patients from Fake Prescription Pills. The free toolkit provides ready-to-use materials to help you educate patients and families about the dangers of counterfeit prescription pills made with fentanyl and other potent chemicals.
Why This Matters in Oregon
According to the CDC, nearly 500 young Oregonians ages 15-24 have lost their lives to overdose in the past five years. Oregon's youth overdose death rate ranks 8th in the nation. Many of these deaths involve fake prescription pills made with fentanyl and other dangerous chemicals that look exactly like real Adderall, Xanax, Percocet, and others. These deaths are preventable through education. Research shows that youth who understand the risks of fake prescription pills are significantly less likely to take pills not prescribed to them by a physician. Brief conversations during and after routine visits can significantly reduce risk—and this toolkit makes those conversations simple for you or your patients’ parents or caregivers.
What's in the Toolkit
Developed by Song for Charlie with input from Oregon clinicians and public health partners, the toolkit includes:
- Background materials on youth fentanyl risks and current statistics
- Email and newsletter templates ready to copy-paste
- Printable waiting room materials (posters, brochures)
- Age-specific post-visit handouts for parents and for older teen patients
- All materials are evidence-informed, non-stigmatizing, and designed for turnkey use.
Access the Toolkit
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Clackamas County Social Services Division Community Needs Assessment
To better understand community experiences and service provider perspectives across the county, Clackamas County Social Services Division just launched a Community Needs Assessment survey.
Every three years, Clackamas County Social Services develops a plan to guide how it addresses poverty and basic needs in the community. This survey helps identify the challenges residents face in meeting basic needs and what programs, resources, and services are most needed.
The survey takes about 15 minutes to complete, is confidential, and is available in English, Spanish, Russian, Vietnamese, and Chinese (Simplified Mandarin). The information collected will help guide future county social services planning, funding priorities, and service improvements. Please share the survey with your clients and families. And please share your feedback through the service provider survey which will help us to understand system gaps, challenges, and opportunities for collaboration.
Both surveys are open through February 2026.
Thank you!
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Effective April 1, 2026: New PA Requirements for Radiology & Diagnostic Cardiology Codes
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:
- Wellcare By Trillium Advantage Medicare Pre-Authorization Check
- Wellcare By Health Net Medicare Pre-Authorization Check
- Health Net Commercial Pre-Authorization Check
- Trillium Community Health Plan Medicaid Pre-Authorization Check
Please view this notice (PDF) for updated Evolent prior authorization requirements. The notice lists Radiology and Diagnostic Cardiology (RBM) codes that will be removed from Evolent’s Utilization Review Matrix and no longer require prior authorization effective April 1, 2026.
Thank you!
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Trillium Provider Orientation Sessions
Please join our Provider Engagement team for a hosted virtual orientation session for all new contracted providers and currently contracted providers who would like updates for 2026.
- Wednesdays, January 7-February 25, 2026 (choose which date works best for you)
- 12:00-1:00 p.m.
- Register for Trillium Provider Orientation
All sessions will contain the same content and will cover the following topics important to providers, including:
- Trillium website – tips and tour of resources
- Introduction to provider portals
- Credentialing
- Claims submission
- Prior authorization check tool
- Interpreter services
- Family planning and women’s healthcare services
- Population Health case management services
- Behavioral Health services
- Free clinical trainings
- Access and availability provider appointment standards
- How to connect with your dedicated Provider Engagement Account Manager
Note: If you need accommodations or would like to schedule an individual session for your team/provider group, please contact ORProviderExperience@TrilliumCHP.com.
We look forward to connecting with you!
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