Manuals, Forms and Resources
Forms
- 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)
- Medicare PA Form - Inpatient (PDF)
- Medicare PA Form - Outpatient (PDF)
- Medicare BH PA Form - Inpatient (PDF)
- Medicare BH PA Form - Outpatient (PDF)
- Medicaid BH PA Form - Inpatient (PDF)
- Medicaid BH PA Form - Outpatient (PDF)
- ABA Reference Checklist (PDF)
- Pharmacy Lock-in Referral Form (PDF)
- Provider Redetermination Request Form (PDF)
- Wellcare by Trillium Provider Claim Dispute Resolution Request (PDF)
- Trillium Medicaid Provider Claim Dispute Resolution Request (PDF)
- Prior Authorization Forms for Specialty Drugs
Resources
- Find a Provider: Medicare | Medicaid - Search for a participating provider in our online Provider Directory
- Member Referral Workflow - by specialty
- Member Referral Workflow (OHP Service Types) - by county
- 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)
Traditional Health Worker Resources
- Steps to Becoming a Certified Community Health Worker (PDF)
- Steps to Becoming a Certified Birth Doula (PDF)
- Steps to Becoming a Certified Personal Health Navigator (PDF)
- Steps to Becoming a Certified Peer Support Specialist (PDF)
- Steps to Becoming a Certified Peer Wellness Specialist (PDF)
- Who are Traditional Health Workers (PDF)
Member ID Cards
MEDICAID
- Trillium Medicaid Lane County Member Card Front (PNG)
- Trillium Medicaid Lane County Member Card Back (PNG)
- Trillium Medicaid TRI County Member Card Front (PNG)
- Trillium Medicaid TRI County Member Card Back (PNG)
MEDICARE
CCO Metrics
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.
OHP Member Referrals
Trillium is dedicated to supporting the provider community by sharing resources to assist members with accessing care.
To assist providers, we offer a list of contracted specialists, sorted by specialty and county. This list does not contain primary care, behavioral health or most ancillary care, as it is focused on provider taxonomy.
The second is a list of contracted providers, sorted by county, and then by type of service, again excluding primary and behavioral care.
Pharmacy
- Trillium Preferred Drug List (PDL) List of Covered Drugs - Oregon Health Plan (PDF)
- Trillium Preferred Drug List (PDL) List of Covered Drugs (PDF) - Oregon Health Plan (JSON)
- Trillium Preferred Drug List Alternatives (PDF)
Transportation Benefit for OHP Members
Trillium OHP members may qualify for transportation assistance to get to and from medical, dental, and mental health appointments.
In Lane County, RideSource provides this service. Read the Transportation Benefit flyer (PDF) for details.
In the Portland metro area, MTM provides this service. Email the Community Outreach Team at CO-OR@mtm-inc.net or phone the Contact Center 24/7 at 1-877-583-1552.
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.