Skip to Main Content

Provider Digest | Volume 135

Date: 08/07/24

Help Shape Health Equity in Healthcare

To help shape health equity in healthcare, please take the Provider Health Equity & Technology Survey today! Trillium is committed to partnering with you to support culturally competent care for our members.

We use your feedback to:

  • Identify areas of need in our network
  • Inform our community health equity initiatives
  • Develop provider resources to help improve access to care and health outcomes

Take the online survey here – Your responses are due by 12/31/24.

Thank you for your partnership in helping our members stay healthy. If you have any questions, please reach out to your Provider Relations Representative or call Provider Services at 1-877-600-5472.
 
Note: If you would like to gather the information before taking the online survey, please view the Provider Health Equity and Technology Survey in PDF format.

______________________________________________________

Pharmacy Update for Medicaid Providers: Appropriate Use of GLP-1 Agonists

GLP-1 agonists have become part of the standard of care in the treatment of Type II Diabetes. The American Diabetes Association (ADA) guidelines now recommend other medications (including GLP-1 agonists), with or without metformin based on glycemic needs, as appropriate initial therapy for individuals with Type II Diabetes with or at high risk for atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease. Inappropriate prescribing of drugs like Ozempic and Mounjaro for treatment of obesity alone has contributed to shortages of these products for patients with Type II Diabetes.

In recent months we have noted that many coverage requests for GLP-1 agonists (particularly Ozempic and Mounjaro) appear to be intended for use outside of the FDA-approved indications for the particular product. Trillium Community Health Plan (Trillium), in conjunction with Centene Pharmacy Solutions, will be actively monitoring and reviewing PA requests to ensure these medications are used only per their FDA-approved indications. Requests for documentation to substantiate attestations made in the prior authorization (PA) request process may be required.

It is also important to note Trillium does not cover products with weight loss indications as pharmacologic treatment of obesity is an excluded benefit of the Oregon Health Plan.

For more details, please review this document about the Appropriate Use of GLP-1 Agonists from Trillium's Pharmacy Department.

______________________________________________________

Effective October 1, 2024: Expanded Requirements for Genetic & Molecular Testing Billing for Wellcare Providers

Genetic testing has increasingly become the standard of care, and Wellcare By Health Net (Wellcare) and Wellcare By Trillium Advantage (Wellcare) are committed to providing the highest levels of access, quality, and value for our members in this exciting and dynamic segment of healthcare. To achieve these goals, we are asking for your support in the next phase of our genetic testing program as we aim to advance the reliability of laboratory quality information and reduce variability in billing

Beginning October 1, 2024, Wellcare will expand the requirements for billing of genetic and molecular testing. Our partner Concert Genetics (Concert) will facilitate the quality and billing integrity requirements in the reimbursement policy for Genetic/Molecular Test Coding. Concert is a software and managed services company that promotes health by providing the digital infrastructure for reliable and efficient management of genetic testing and precision medicine. In accordance with the reimbursement policy, all providers billing for genetic and molecular testing services will be required to adhere to the coding recommendation in the Concert Genetics portal. Concert will reach out directly to all affected Medicare providers to assist with the registration process.
 
What are the next steps for our laboratory partners?

  • Register with Concert Genetics using the Concert Genetics portal
  • Self-report on quality metrics in a common framework supplied by Concert 
  • Verify accuracy of test catalog, and view coding recommendations and fee schedule
  • Utilize Concert's recommended codes when billing for genetic and molecular tests

Thank you for your support and continued partnership in providing our members access to high-quality healthcare at an affordable price. If you have any questions, please contact your assigned health plan Provider Engagement Representative.

.______________________________________________________

Reminder: Oregon Medicaid & Medicare Appointment Availability Standard Requirements

At Trillium Community Health Plan (Trillium), Wellcare By Health Net (Wellcare), and Wellcare By Trillium Advantage (Wellcare), we view providers as essential partners in making sure our members get the quality care they need to have the best possible healthcare experiences and outcomes.

Trillium and Wellcare require providers to follow the appointment accessibility standards of the Oregon Health Plan, the Oregon Administrative Rules (OARs), and applicable accrediting agencies. Following the state’s guidelines is necessary to achieving our shared goal of providing critical care to our members, your patients. 

Trillium and Wellcare monitor compliance with the appointment accessibility standards on a bi-annual basis using a telephonic survey. Thank you to all the providers who participated in our most recent audit.

For more information about  the Oregon appointment availability standards, please review the below flyers:

As always, we deeply appreciate the valuable work that you are doing for our members and our community at large. If you have any questions about the Medicare and Medicaid Access standards, please email your assigned provider engagement representative or email the health plan at OR_Prov_Reps@TrilliumCHP.com.

______________________________________________________

Hot Weather & Wildfire Resources

This summer we are already experiencing hot weather and wildfires. 

Please visit Trillium's Hot Weather Safety webpage and Northwest Wildfires webpage to find links to a variety of information and resources to help your patients stay safe this summer, including cooling centers, air quality monitoring, public alerts and more.

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

______________________________________________________