Auditing
This is often sent 28 days before a monitoring is scheduled to take place
What is a Monitoring Notification Letter
This multi-year agreement outlines the requirements needed to remain in compliance according to federal and state regulations and Trillium’s waiver participation.
What is a Procurement Contract (and a set of General Terms and Conditions)
The fundamental precepts of this training include developing respect for differences; cultivating successful approaches to diversity; increasing awareness of one’s self and of unstated institutional cultural norms and practices; and having a working knowledge of the history, culture, beliefs, values and needs of diverse members and communities.
What is Cultural Competency
ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
What are Accountable Care Organizations
This team supports network providers by addressing provider concerns and questions through the Network Services Ticket System.
What is Network Engagement
A formal plan that is developed by the solo, group practice, or agency billing only outpatient services to address the out of compliance issue(s), inclusive of action(s) already taken or action(s) that will be taken to maintain compliance in follow up to the review, and must be submitted within a specified timeframe.
What is a Plan of Correction
All providers and Licensed Clinicians/Behavioral Healthcare Professionals credentialed with Trillium are required to have their credentials reviewed and verified within this time frame
What is every 3 years
Trillium disseminates critical and/or time-sensitive information through this
The Network Communication Bulletins and/or Clinical Communication Bulletins.
SE/IPS is an evidence-based practice that helps people with mental illness and other disabilities identify and acquire part-time or full-time jobs of their choice in the community with rapid job-search and placement services.
What is Supported Employment/Individual Placement Support
This department is responsible for the development and maintenance of the provider network to meet the needs of members while ensuring choice and best practices in services.
What is the Network Management Department
The reviewer should observe all areas of the house and grounds to ensure that there are no safety hazards identified, offensive orders or insects/rodents during this review type
What is an Unlicensed Alternative Family Living (UAFL) walk through
This is the exclusive Web portal for contracted network providers to enroll new individuals, search for members, update member information, submit treatment authorization requests (TARs), view authorization letters, and submit claims for processing.
What is Provider Direct
This must be submitted when requesting the following services: Supported Employment Services (H2025), Initial Supported Employment (H2023), Residential Supports (H2016), Residential Supports (T2016), Day Supports (T2021), and Day Supports Developmental Day (T2027).
What is a Home and Community Based Service Assessment (HCBS)
SACOT includes a structured program providing individual counseling and support, group counseling, family counseling, life skills, strategies for relapse prevention, and biochemical assays to identify recent drug use.
What is Substance Abuse Comprehensive Outpatient Treatment Program
This team is comprised of 2 separate units: Network Auditing and Program Integrity.
What is Network Accountability
This happens on a 2 year cycle for all providers that are nationally accredited.
What is a Post Payment Review
The new multi-payer Medicaid Management Information System for the NC Department of Health and Human Services.
What is NC Tracks
Defined as any expression(s) of dissatisfaction about any matter other than a Adverse Benefit Determination (see definition of action below) filed by a member or by an individual who has been authorized in writing to file on behalf of a member.
What is a grievance
PRTF is a non-hospital facility offering intensive inpatient services through Medicaid to people who have various mental health issues and are under the age of 21.
What is Psychiatric Residential Treatment Facility
This process at Trillium is based on the accrediting bodies’ credentialing standards and incorporates contractual and policy requirements set forth by the N.C. Department of Health and Human Services (DHHS).
What is Provider Credentialing
A needs assessment tool that, when administered properly, measures an individual's level of intensity of need for developmental disabilities (DD) supports and services.
What is NC-SNAP
A Medicaid program that serves people who would otherwise live in an intermediate care facility for people with intellectual disabilities (ICF/IID).
What is the NC Innovations Waiver
This begins at the time of the initial assessment and is an integral part of every member’s treatment plan regardless of the level of care being delivered.
NCPDP is a not-for-profit standards development organization
What is the National Council for Prescription Drug Programs
This team is responsible for leading Trillium’s development of performance and value based payment strategies.
What is Practice Management