Manuals, Forms and Resources
- 2019 Medicare Provider Manual (PDF) - Reference for Trillium Advantage product
- 2019 Trillium OHP Provider Manual (PDF)
- 2019 OHP Billing Manual (PDF) - Reference for Trillium Medicaid (OHP) product
- Prior Authorizations and Appeals Guide (PDF) - effective January 1, 2019
- ARQ Changes Frequently Asked Questions (PDF) - effective April 1, 2017
- ERA Form (PDF) EDI-Sign up for Electronic Data Interface (electronic claims submission)
- OHP Non-formulary Review Request Form (PDF)
- PA Form-Inpatient (PDF)
- PA Form-Outpatient (PDF)
- PA Form-Pharmacy (PDF)
- Pharmacy Lock-in Referral Form (PDF)
- Provider Redetermination Request Form (PDF) updated 7/19/2019
- Find a Provider: Medicare | Medicaid - Search for a participating provider in our online Provider Directory
- LineFinder - Search for a diagnosis, procedure, or service
- Secure Provider Portal - Check eligibility, PA's, claims for dates of service after 2016
Claims and Payment
- NIA - Submit prior authorizations for non-emergent outpatient advanced imaging.
- NUCC Guidelines (PDF) - Instructions on how to complete the 1500 Claim form
- PaySpan - Signup for Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT).
- Trillium Qualified Medicare Beneficiaries Billing (PDF)
Member ID Cards
The Oregon Health Authority (OHA) uses quality health metrics to show how well Coordinated Care Organizations (CCOs) are improving care, making quality care accessible, eliminating health disparities, and curbing the rising cost of health care. Measures fall into one or more categories:
- CCO Incentive measures, for which CCOs are eligible to receive payments based on their performance each year (CCO Quality Incentive Program pay-for-performance measures); and
- State Quality measures, which OHA has agreed to report to the Centers for Medicare and Medicaid Services (CMS) as part of Oregon's 1115 Medicaid waiver.
Learn about CCO metrics and how plans perform on the CCO Metrics page of the OHA website.
- Trillium Preferred Drug List (PDL) List of Covered Drugs for 2019 - Oregon Health Plan (PDF)
- Trillium Preferred Drug List (PDL) List of Covered Drugs for 2019 - Oregon Health Plan (JSON)
- Trillium Preferred Drug List Alternatives (PDF) revised 8/1/2019
Prevention and Well Care
- Living Well Self-Management Programs Living Well is a series of Self-Management Programs developed by Stanford University to help you live and cope with a range of chronic conditions. Workshops include Living Well with Chronic Conditions, Living Well with Diabetes, and Living Well with Chronic Pain.
- Trillium Community Health Plan promotes adherence to the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) periodicity schedule. View the Recommendations for Preventive Pediatric Health Care schedule of screenings (PDF) from the American Academy of Pediatrics.
- Trillium is pleased to introduce the Choosing Wisely initiative. The American Board of Internal Medicine (ABIM) Foundation encourages practitioners and patients to "Choose Wisely." This initiative seeks to advance a national dialogue on avoiding unnecessary medical tests, treatments and procedures. Please visit choosingwisely.org to download informational resources for your patients and clinicians to promote shared-decision making.