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Provider Digest | Volume 232

Date: 09/02/26

Trillium Medicaid Prior Authorization Update for Behavioral Health

Trillium would like to share an important prior authorization update to procedure code, H2032 – Activity therapy, per 15 minutes.

For participating providers, H2032 falls under Conditional Prior Authorization Required after the first 104 units per member, per calendar year.  

Requirements will mirror recent changes to similar treatment service codes. This change will be effective November 1, 2026. The 104-unit accumulator will begin on November 1, 2026, and units rendered prior to that date will not count toward the accumulator.

Please verify member eligibility and benefits before services are rendered. Payment remains subject to the member’s eligibility on the date of service.

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

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Effective on or After November 1, 2026: Trillium Medicaid Behavioral Health Billing/Coding Edits

Thank you for your continued partnership with Trillium Community Health Plan (Trillium). As you know, we are committed to continuously evaluating and improving overall Payment Integrity solutions as required by State and Federal governing entities. We are writing today to inform you of an update that Trillium will be implementing effective on or after November 1, 2026.

These Trillium Medicaid Behavioral Health edits are designed to promote accurate billing and coding practices, ensure consistency with nationally recognized coding standards and industry guidelines, and support appropriate reimbursement for services rendered.

Edit: INOP
Language: PROCEDURE IS CLASSIFIED INPATIENT ONLY BY CMS
Description: Procedures that CMS requires performed at an inpatient only setting

Edit: NEWP
Language: INAPPROPRIATE USE OF NEW PATIENT E/M CODE PER AMA GUIDELINES
Description: E&M service billed with a new patient E&M code when the provider has billed other services for the same patient within the past 3 years

Edit: AOC
Language: EOP: RETAIN PEND: PRIMARY CODE BILLED FOLLOWING ADD ON CODE DENIAL-REVIEW PEND
Description: Payable Primary Code submitted after Add on Code denial

Edit: INDX
Description: DIAGNOSIS CODE INVALID PER ICD10 MANUAL

Edit: GBLS
Language: INCLUDED IN GLOBAL SURGICAL PACKAGE
Description: E/M service is included within post operative surgical global period and if billed within designated surgical global period, it is denied.

Edit: OPIP
Description: Edit fires in I2 business unit when there is an inpatient and outpatient facility claim with overlapping dates of service for the same member. I2 BUSINESS UNIT ONLY.

Thank you for your continued participation and cooperation in our ongoing efforts to render quality health care to our members. We look forward to helping you provide the highest quality of care for our members.

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Lane County Tobacco Treatment Series: Motivational Interviewing and Tobacco Treatment

Trillium is proud to sponsor "Motivational Interviewing and Tobacco Treatment," a two-day training facilitated by Lisa Carlson, a licensed marriage and family therapist who holds a National Certificate in Tobacco Treatment Practice (NCTTP) and is designated a UMASS Tobacco Treatment Specialist Trainer. She presents regularly within community and educational settings on topics related to mental health, addiction, and counseling practices.

This highly interactive course will provide an introduction to the Motivational Interviewing (MI) framework and basic skills while incorporating discussion around tobacco use and treatment. There will be exploration of how MI can help engage client motivation for change while decreasing frustration for both the client and provider.

  • September 28-29, 9:00 a.m.-4:00 p.m.
  • Goodson Training Room, Lane County Public Works Building, 3040 N. Delta Highway, Eugene, OR 97408
  • Free for Lane County, Reedsport, and Harrisburg OHP providers and community partners; $80 for all other participants
  • Lunch and parking provided
  • 11 MHACBO approved CEUs available
  • Register for the training

Download the flyer (PDF) for more information.

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Monthly Trillium Provider Orientation Sessions: Choose the Date that Works Best for You

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.

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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