---
title: "Trillium Community Health Plan ABA coverage in Oregon: the intake guide."
url: "https://carelu.com/payers/trillium-community-health-plan-oregon"
markdown_url: "https://carelu.com/payers/trillium-community-health-plan-oregon.md"
state: OR (Oregon)
payer: Trillium Community Health Plan (Oregon)
kind: Medicaid managed care plan (MCO)
parent_program: Oregon Health Plan (Coordinated Care Organizations)
description: "How Trillium Community Health Plan covers ABA for OHP members in Lane, Clackamas, Multnomah and Washington counties: its ABA request checklist, the PA check tool, 7-day decisions, peer-to-peer timing, and claims dispute deadlines."
last_reviewed: October 2026
---

# Trillium Community Health Plan ABA coverage in Oregon: the intake guide.

_Payer Guide · Trillium Community Health Plan · Oregon · Last updated October 2026 · 19 primary sources_

> Centene CCO for Lane and the Portland tri-county area: code-level PA tool, an ABA request checklist, 7-day decisions and 180-day dispute window.

Trillium Community Health Plan (Centene) is the OHP CCO for Lane County and one of two CCOs in Clackamas, Multnomah and Washington counties, plus parts of Douglas and Linn. Most Lane County members who were with PacificSource moved to Trillium on February 1, 2026. Trillium publishes an ABA request checklist and a service authorization handbook; code-level prior-authorization rules sit in its online PA check tool.

This plan administers the **Oregon Health Plan (Coordinated Care Organizations)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Oregon Health Plan (Medicaid) guide](https://carelu.com/payers/oregon-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Trillium Pre-Authorization Check Tool (trilliumohp.com → Providers) for 97151 and 97152, or Trillium Provider Services, 877-600-5472. [3][4]
- **Prior auth for treatment**: Yes: ABA treatment goes through Trillium’s prior-authorization process with its Applied Behavioral Analysis Outpatient Treatment Request Checklist (initial and ongoing requests) [4][3]
- **Autism diagnosis required?**: Yes: Trillium’s checklist asks for a "Comprehensive diagnostic evaluation (typically within 0-5 years) indicating diagnosis eligible for ABA treatment," and its handbook reviews coverage first against the Prioritized List (ASD on Line 192 under OHP rules) [4][3][10]

## At a glance

- **Covers ABA?:** Yes, under OHP rules; coverage reviewed first against the Prioritized List
- **Service area:** Lane, Clackamas, Multnomah, Washington; parts of Douglas and Linn
- **Prior auth:** Treatment: yes (ABA request checklist). Assessment: check the PA tool
- **Decision clock:** 7 calendar days standard, 72 hours urgent
- **Peer-to-peer:** Request within 48 hours / 2 business days of the notice
- **Claim disputes:** 180 calendar days from the Explanation of Payment

## Authorization: the checklist and the handbook

Trillium’s Service Authorization Handbook says its "Pre-Authorization (PA) Check Tool ... indicates if an item or service currently requires prior authorization," and that determinations are "based on review of Oregon Health Plan (OHP) coverage, first regarding the funding per the Prioritized List, and then evaluated for medical appropriateness." Symptom codes "will not result in authorization approval," so use a condition code. Services must be furnished in no less amount, duration and scope than under OHP fee-for-service. [3][4]

For an initial ABA request, the checklist asks for the diagnostic evaluation and ABA recommendation, social, developmental and medical history, prior and current services (Early Intervention, IEP, OT, PT, speech), requested codes and dates, a proposed weekly schedule including school and naps, age-appropriate assessment data (VB-MAPP, ABLLS-R, AFLS, EFL and others), measurable goals with mastery criteria, operational definitions and baselines for behaviors targeted for reduction (with an FBA and BIP), caregiver-training goals, crisis, generalization and transition plans, a parent signature and the provider signature. Ongoing requests add progress on prior goals, barriers, attendance for member and caregivers, and how hours will be titrated. Assessment or reassessment above "the market standard of 8-10 hours" needs member-specific rationale. [3][4]

## Decisions, appeals and claims

Non-urgent pre-service decisions are made "within 7 calendar days of receipt of the request," with one extension of up to 14 days; urgent decisions within 72 hours. "Practitioners have 48 hours or 2 business days from date of notice to request peer-to-peer discussion." Trillium’s 2026 provider manual sets the claim-side deadline: "All corrected claims, requests for redetermination, or claim disputes must be received within 180 calendar days from the date of the Explanation of Payment." For initial claims, OHA’s CCO billing rule sets 120 days from the date of service (365 days for exceptions such as other insurance). [3][2][1]

## Claim filing and payment rules for Trillium

OHA’s managed-care billing rule binds every CCO, Trillium included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff. Trillium’s 2026 provider manual adds its own clock for fixes: "All corrected claims, requests for redetermination, or claim disputes must be received within 180 calendar days from the date of the Explanation of Payment (EOP)," and Trillium finalizes them within 45 business days of receipt. The manual points to the separate Trillium OHP Billing Guide for initial-claim instructions, which was not read for this guide. [1][2]

## Intake gates

The questions that decide whether a family can start with Trillium Community Health Plan (Oregon), and what they have to bring.

- **Age limit**: Trillium publishes no age limit. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials. [4][10][18]
- **Diagnosis recency**: Trillium’s checklist asks for a comprehensive diagnostic evaluation "typically within 0-5 years"; ongoing requests should include updated diagnostic testing if previously requested. [4]
- **Who may diagnose**: Trillium asks for a recommendation "from a qualified provider" without naming types, so the OHP rule applies: a physician, psychologist, or developmental-medicine NP or PA experienced in autism (OAR 410-172-0770(1), 0760(1)). [4][10][9]
- **Diagnostic tools required**: Trillium names treatment-planning tools (VB-MAPP, ABLLS-R, AFLS, EFL) but no diagnostic instrument, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status on assessments such as the Vineland (OAR 410-172-0770(1)(b), (g)). [4][10]
- **Referral required?**: Trillium’s checklist asks for the ABA recommendation "from a qualified provider, if required." Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)). [4][10][9]
- **Telehealth**: Trillium’s ABA documents publish no telehealth rule of their own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification. [4][12][13]
- **Prior-auth decision time**: Non-urgent pre-service decisions within 7 calendar days of receipt; urgent within 72 hours; one extension of up to 14 days. Peer-to-peer must be requested within 48 hours or 2 business days of the notice. [3][14]
- **Other insurance (who pays first)**: Trillium’s documents read add nothing ABA-specific, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules. [2][17][20]

## Delivery and billing rules

Coverage decides whether Trillium Community Health Plan (Oregon) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Trillium’s ABA checklist and handbook publish no supervision ratio, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005). [4][3][9][16]
- **Daily limits / MUEs**: No numeric cap is published. Assessment or reassessment above 8–10 hours needs rationale, and a request must explain any gap between hours requested and the member’s availability. [4]
- **Session-note signature**: Trillium’s checklist requires the caregiver’s and the provider’s signature on the treatment plan but no session-note rule. The OHP floor applies: each service note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)). [4][11]
- **Bill as provider**: Trillium publishes no ABA rendering-provider rule. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)). [4][9]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in Trillium’s ABA checklist, authorization handbook or 2026 provider manual. [4][2]
  - Ask the plan: Trillium Provider Services, 877-600-5472, or your Trillium participation agreement.
- **Place of service** _(ask the plan)_: Not addressed beyond the checklist’s request for a full weekly schedule (school, other therapies) and school-transition planning for members in full-time ABA. [4]
  - Ask the plan: Trillium Provider Services, 877-600-5472: ask which settings and place-of-service codes it pays for ABA.

## What intake should collect for Trillium Community Health Plan (Oregon)

- **Member ID:** Confirm Trillium on the date of service; Lane members moved from PacificSource on 2/1/2026.
- **Diagnostic evaluation:** Comprehensive evaluation, typically within 0–5 years, plus the ABA recommendation; must also meet OAR 410-172-0770.
- **Schedule and other services:** Weekly schedule with school, naps and other therapies; IEP and Early Intervention status.
- **Caregiver sign-off:** Parent signature showing participation in and understanding of the plan.
- **Other insurance:** Bill commercial coverage first; OHP is the payer of last resort.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### What is Trillium’s timely filing limit for ABA claims?

120 days from the date of service under OAR 410-141-3565 (365 days for exceptions such as retroactive eligibility, Medicare or other insurance primary); your contract may set a shorter limit. Corrections and resubmissions get at least 180 days from the initial adjudication. Trillium’s manual allows corrected claims within 180 calendar days of the EOP.

### Does Trillium cover ABA for OHP members in Lane County?

Yes. Trillium is the CCO for Lane County; most former PacificSource Lane members moved to Trillium on February 1, 2026.

### What does Trillium need for an initial ABA request?

Its ABA checklist: diagnostic evaluation and recommendation, history, prior services, codes and dates, weekly schedule, assessment data, measurable goals, FBA/BIP for reduction targets, caregiver goals, crisis, generalization and transition plans, and parent and provider signatures.

### How long does Trillium have to decide an ABA authorization?

7 calendar days for standard requests and 72 hours for urgent ones, with one possible 14-day extension.

### How long do I have to dispute a Trillium claim?

180 calendar days from the date of the Explanation of Payment, for corrected claims, redeterminations and disputes.

## Primary sources

1. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, DMAP 143-2024, eff. 01/01/2025): §§ (1)(a)–(c), (6), (8)(b), (8)(d)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
2. [Trillium Community Health Plan — Provider Manual 2026 (Requests for Redetermination)](https://www.trilliumohp.com/content/dam/centene/trillium/ProviderResources/ProviderManuals/ProviderManual%202026_FINAL_R.pdf)
3. [Trillium Community Health Plan — Medicaid (OHP) Service Authorization Handbook: Authorization or Denial of Covered Services](https://www.trilliumohp.com/content/dam/centene/trillium/ProviderResources/ProviderManuals/TrilliumMedPrvdrOhpAuth.pdf)
4. [Trillium Community Health Plan — Applied Behavioral Analysis Outpatient Treatment Request Checklist](https://www.trilliumohp.com/content/dam/centene/trillium/ProviderResources/ProviderForms/OR-ABA-Request-Tip-sheet.pdf)
5. [Trillium Community Health Plan — Provider Manual 2026](https://www.trilliumohp.com/content/dam/centene/trillium/ProviderResources/ProviderManuals/ProviderManual%202026_FINAL_R.pdf)
6. [Trillium Community Health Plan — Provider forms and resources](https://www.trilliumohp.com/providers/resources/forms-resources.html)
7. [OHA — Coordinated Care Organization (CCO) Plans (CCO list by county, read from the page’s CCO Plan Details list)](https://www.oregon.gov/oha/HSD/OHP/Pages/Plans.aspx)
8. [OHA — Lane County CCO Transition: Reminder for Members (updated 03/23/2026)](https://www.oregon.gov/oha/HSD/OHP/Tools/Lane-County-Transition-Member-Reminder-EN.pdf)
9. [OAR 410-172-0760 — Applied Behavior Analysis (OHA, eff. 01/09/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0760)
10. [OAR 410-172-0770 — Individual Eligibility for Applied Behavioral Analysis Treatment (OHA, DMAP 12-2017)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0770)
11. [OAR 410-172-0620 — Documentation Standards, Medicaid behavioral health (OHA, eff. 6/26/2015)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0620)
12. [OAR 410-172-0850 — Telemedicine for Behavioral Health (OHA, DMAP 67-2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0850)
13. [OHA — OHP Fee-for-Service Behavioral Health Fee Schedule, Applied Behavior Analysis tab (update published 7/1/2026)](https://www.oregon.gov/oha/HSD/OHP/DataReportsDocs/bh-fee-schedule0726.xlsx)
14. [OAR 410-141-3835 — CCO Service Authorization (OHA, eff. 07/01/2026)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3835)
15. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, eff. 01/01/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
16. [OAR 824-040-0010 — Training and Supervision of registered behavior analysis interventionists (eff. 2/1/2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-040-0010)
17. [OAR 410-120-1280 — Billing (third-party resources; OHA as payer of last resort)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-120-1280)
18. [OHA — EPSDT Provider Guide (March 2026)](https://www.oregon.gov/oha/HSD/OHP/Tools/EPSDT-Provider-Guide.pdf)
19. [Trillium Community Health Plan — Provider News & Updates (Provider Digest archive)](https://www.trilliumohp.com/providers/provider-news.html)
20. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?part=433&section=433.139)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.