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Provider Digest | Volume 190

Date: 10/01/25

Effective October 1, 2025: Trillium Re-Opens Applications for Medicaid Flexible Services Requests

Trillium will accept applications for new flexible services for Medicaid members beginning October 1, 2025. 

Flexible services are items and services that can help improve a member's health. Flexible services are not benefits covered by the Oregon Health Plan. They are voluntary items and services provided by Trillium.

Examples might be:

  • Access to a warm pool to swim to help with arthritis and improve movement
  • A place to stay for a while to heal and get stronger after surgery when a member does not have a home to return to
  • A tablet to use to virtually join groups that a member's counselor or provider has recommended 

How to help a Trillium member apply for flexible services
Providers, community partners, and member representatives can complete and submit a flexible services application on behalf of a Trillium member:

Trillium members can also complete and submit the flexible services request form. If they need help, they can call Trillium Member Services at 1-877-600-5472 and ask to speak with a care manager.

Thank you for your patience and for your partnership in helping our members stay healthy! If you have any questions, please contact your Trillium Provider Engagement Representative.

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Adobe Population Health Services Available for Wellcare By Health Net and Wellcare By Trillium Advantage Members and Providers

Adobe Population Health started serving Wellcare by Health Net and Wellcare By Trillium Advantage members as of August 1, 2025. Adobe Population Health has many services available for you and your Wellcare Medicare patients, including in-home assessments.

Adobe Population Health will contact your Wellcare patients to schedule in-home assessments. These 45-minute health reviews with an Adobe Population Health provider include a check of the patient’s vital signs (if necessary), a medication review and a discussion of their medical history. The provider’s notes from this appointment will be sent to their primary care physician. You will also receive the credit for care gaps closed during the visit.

As a Wellcare network provider, Adobe Population Health’s services are free of charge to you and your Wellcare patients. We're pleased to offer this added level of care to support you and reduce your administrative burden.

To learn more, please review the Adobe Population Health flyer (PDF) or call Adobe Population Health Customer Service at 800-941-9270.

As always, your Wellcare By Health Net and Wellcare By Trillium Advantage Provider Engagement Representative is available to support you or answer any questions:

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Effective October 1: Trillium and Wellcare Launch Partnership with Healthmap Solutions for Kidney Health Management 

Starting October 1, 2025, Trillium Community Health Plan (Trillium), Wellcare By Health Net (Wellcare), and Wellcare By Trillium Advantage (Wellcare) launch our partnership with Healthmap Solutions (Healthmap) to provide care coordination services within our kidney health management (KHM) program. As a leading national kidney health management company, the partnership with Healthmap will provide more comprehensive care for members with chronic kidney disease (CKD) stages 3, 4, 5, and end stage renal disease (ESRD).

If you have a patient with kidney disease, or chronic conditions that may lead to kidney disease, Healthmap may contact you to facilitate care. Healthmap provides collaborative recommendations through workflow-friendly clinical decision support.

Healthmap’s KHM program integrates into your existing practice workflow to complement your patient’s current plan of care. Healthmap can supply you with actionable information, based on industry proven best practices, and powered by data analytics, to more effectively anticipate and deliver the right clinical care.

We appreciate your ongoing care for our members. Be on the lookout for outreach from Trillium, Wellcare, and Healthmap for the introduction to our kidney health management (KHM) program. If you have any questions or concerns, please contact your assigned health plan Provider Engagement Administrator:

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Effective January 1, 2026: Use Availity Essentials for Health Net and Wellcare Behavioral Health Initial Precertification Requests

Earlier this year, Health Net and Wellcare By Health Net Behavioral Health announced a shift to using Availity Essentials as the preferred method for initial facility precertification requests.
 
Please note that effective January 1, 2026, Availity Essentials will be the primary method for Health Net and Wellcare Behavioral Health initial precertification requests.

Availity Provider Registration

Please register and prepare for this transition today! In-network and out-of-network facility providers are encouraged to register and access Availity Essentials on the registration page of the Availity website.
 
Once you set up an account and log in, Availity training webinars can be found by navigating to the Availity Learning Center (ALC). From the home page, select Help & Training > Get Trained > Sessions tab to view the calendar of upcoming sessions.
 
For more information about Availity Essentials, please visit the Availity website or call Availity Client Services at 800-282-4548 (Monday–Friday, 5 a.m.–5 p.m. PT).
 
Secondary Fax Option
Faxed precertification requests will also be accepted.

Note: If your request is for routine psychotherapy or medication management, Transcranial Magnetic Stimulation (TMS), Applied Behavioral Analysis (ABA) or Psychological/Neuropsychological Testing, please see the "Special Instructions" section of this article.
 
Prior Authorization Fax Request Forms (submit Behavioral Health fax requests to 855-663-2244)

For inpatient psychiatric admission, detoxification, SUD rehab, or MH/SUD RTC (if applicable):

For MH/SUD PHP or MH/SUD IOP:

For facility providers seeking initial precertification without access to Availity or fax, telephonic review will still be available by calling our toll free number though hold times may be significantly longer.
 
Special Instructions

  • Routine psychotherapy and medication management with an in-network provider do not require referral or prior authorization. Do not submit via Availity or fax.
  • Prior Authorization requests for Transcranial Magnetic Stimulation (TMS) or Psychological/Neuropsychological Testing are accepted by email to Admin.HNTBH@healthnet.com or via fax to the following numbers:
    • Transcranial Magnetic Stimulation (TMS) fax: 855-661-0077
    • Psychological/Neuropsychological Testing fax: 855-703-3268
  • Prior Authorization requests for Applied Behavioral Analysis (ABA) submissions are accepted by email to ABA@healthnet.com or via fax to 855-427-4798.

If you need additional assistance, please call 844-966-0298.

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