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Trillium Medicaid, Health Net Commercial and Wellcare Medicare Prior Authorization

Date: 07/31/23

Trillium Community Health Plan, Health Net Plan of Oregon, Inc., Wellcare By Trillium Advantage, and Wellcare By Health Net require prior authorization (PA) as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all commercial, Medicaid, and Medicare products offered.

We are committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.

It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.

Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.

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

Please view this Trillium Medicaid, Health Net Commercial, Wellcare By Trillium Advantage Medicare, and Wellcare By Health Net Medicare Prior Authorization  notice (PDF) for changes to prior authorization requirements effective July 1, 2023.

Thank you for your partnership in helping our members stay healthy. If you have any questions, please contact your assigned Health Plan Provider Relations Representative.