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Provider Digest | Volume 122

Date: 05/01/24

Prior Authorization Codes for Trillium, Health Net and 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. Please view this table (PDF) for prior authorization requirements effective Jan. 1, 2024.

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

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

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Update: Medicare as Primary Payer for Some Outpatient Behavioral Health Services for Dual Members

According to a memo from the Oregon Health Authority (OHA) (PDF), Medicare is the primary payer for some outpatient behavioral health services for Medicare-Medicaid members, effective January 1, 2024. Specifically, Medicare is the primary payer for the following behavioral health services provided to Medicare members:

  • Behavioral health services rendered by Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) as defined by the Centers for Medicare & Medicaid Services (CMS) (PDF). In Oregon, this will include services rendered by Licensed Marriage and Family Therapists. It may also include services rendered by Licensed Professional Counselors.
  • Intensive Outpatient Program (IOP) services furnished by hospital outpatient departments, community mental health centers, rural health clinics, federally qualified health centers, or opioid treatment programs as described in the November 2023 news release from CMS.

The Medicare Learning Network’s guide to Medicare and Mental Health Coverage (PDF) includes details on these changes to coverage, reimbursement and eligible provider types.

MFT and MHC providers who meet federal education and experience requirements should enroll in Medicare. This document lists the education and experience requirements, and how to enroll (PDF). It may take up to 60 days to complete Medicare enrollment.

For more information, including billing tips, please review OHA's April 22, 2024 memo (PDF).

If you have any questions, please contact your assigned health plan Provider Engagement Representative.

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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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Lane County Behavioral Health Resource Networks

Lane County's Behavioral Health Resource Networks (BHRNs) are available to help with substance use peer services and entry to treatment and other supports. There are three BHRNs in Lane County.

If you have a patient you'd like to connect with behavioral health resources, contact a BHRN in your area:

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