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Provider Digest | Volume 154

Date: 01/22/25

Trillium, Health Net and Wellcare Transition to Availity Essentials in January

Trillium Community Health Plan (Trillium), Health Net Health Plan of Oregon, Inc. (Health Net), Wellcare By Health Net (Wellcare) and Wellcare By Trillium Advantage (Wellcare) have chosen Availity Essentials as our new, secure provider portal. Starting January 20, 2025, you can validate eligibility and benefits, submit claims, check claim status, submit authorizations, and access Trillium, Health Net and Wellcare payer resources via Availity Essentials.

If you are already working in Essentials, you can log in to your existing Essentials account to enjoy these benefits for Trillium, Health Net and Wellcare members beginning January 20, 2025: 

  • Use Availity Essentials to verify member eligibility and benefits, submit claims, check claim status, submit authorizations, and more.
  • Look for additional functionality in Trillium's, Health Net's and Wellcare’s payer spaces on Essentials and use the heart icon to add apps to My Favorites in the top navigation bar. Our current secure portal will still be available for other functions you may use today.
  • Access Manage My Organization – Providers to save provider information. You can then auto-populate that information repeatedly to eliminate repetitive data entry and reduce errors.  

If you are new to Availity Essentials, getting your Essentials account is the first step toward working with Trillium, Health Net and Wellcare on Availity.

Getting started: Designate an Availity administrator for your provider organization
Your provider organization’s designated Availity administrator is the person responsible for registering your organization in Essentials and managing user accounts. This person should have legal authority to sign agreements for your organization.

  • If you are the designated Availity administrator for your organization, visit Register and Get Started with Availity Essentials to enroll for training and access other helpful resources.
  • If you are not the designated Availity administrator for your organization, your designated Availity administrator will determine who needs access to Availity Essentials on behalf of your organization and will add user accounts in Essentials.  
  • If you are not sure who will be the designated Availity administrator for your organization, share this information with your manager to help determine who will be the designated Availity administrator for your organization. 
  • Download the Availity Essentials Resources Flyer for helpful tips and information

Training webinars
Starting January 21, we will be hosting webinars to provide an overview of Availity Essentials. You'll learn how to verify eligibility and benefits, submit claims, check claim status, submit authorizations, and more.

  • Sign up for the webinars 
  • Note: Providers are required to sign in to Essentials first, then they will be redirected to the list of webinars.

If you need additional assistance with your registration, please call Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday, 8 a.m. – 8 p.m. ET. For general questions, please reach out to your assigned health plan Provider Engagement Administrator:

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2025 Medicaid Behavioral Health Provider Directed Payment Attestation

Effective January 1, 2025, the Oregon Health Authority (OHA) is implementing the annual attestation process required for qualified Behavioral Health providers for three behavioral health directed payments (DPs) within the CCO contracts that further the goals and priorities of the Medicaid program. All Trillium Medicaid Behavioral Health/Substance Abuse providers who submitted Tier 2 Primarily Medicaid OHA attestations in 2024 are required by OHA to resubmit 2025 attestations to CCOs in order to continue qualifying for Behavioral Health Directed Payment rate tier increases.

Important Note: Please carefully review the criteria for each category when completing your attestation form. OHA has updated the Directed Payment (DP) program and limited qualifying providers to those in the Primarily Medicaid, COD and CLS categories listed below: 

  1. Behavioral Health Primarily Medicaid Directed Payment: attestation to CCO required for this DP
  2. Integrated Co-Occurring Disorder (COD) Directed Payment: OHA approval required for this DP
  3. Culturally and Linguistically Specific Services (CLS) Directed Payment: OHA approval required for this DP

What steps do providers need to take? 

Who do I contact at Trillium if I have questions?
If you have any questions, please contact your assigned Health Plan Provider Engagement Administrator (PEA).You can locate your assigned PEA on our Trillium Regional Reps Contact webpage. 

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Expanded Doula Benefits for Trillium Medicaid Members

Effective January 1, 2025, Trillium Medicaid members are now eligible to receive four additional support visits beyond the visits covered by the standard global birth doula benefit. These additional visits:

  • May occur either before or after birth, in any combination.
  • Are covered for up to 12 months following the end of the pregnancy.
  • May be billed only after delivering the standard global benefit. The standard global benefit includes two (2) prenatal support visits, doula support on day of delivery and two (2) postpartum support visits.

To learn more about fee-for-service billing, please refer to Oregon Health Authority’s (OHA)  updated Birth Doula Billing Guide.

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

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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.

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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