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Provider Direct

Provider Direct is your online resource to make sure members get the appropriate care.

Login to Provider Direct

Through Provider Direct you can:

  • Enroll new members
  • Update clinical documentation
  • Create treatment authorization requests
  • View claims
  • Submit claims
  • View client information
  • Access training and instructional videos

Frequently-asked questions


Q. How do I enroll new patients referred to me through the Access Call Center?

A. Patients may seek enrollment with a provider by calling our Access Call Center. If a caller has been referred to you for an assessment, the enrollment data will be forwarded to you via Provider Direct. Once you've received and reviewed the data, follow these steps:

  • Conduct your own assessment and complete the "Additional Enrollment Data" on the enrollment form.
  • Collect information on the person's ability to pay.
  • Submit the completed enrollment to Cardinal Innovations via Provider Direct.
We will then review the enrollment for completeness.

Q. How do I file a claim or inquiry to receive payment?

A. Submit claims through Provider Direct or an 837 file, unless your contract states another method. We encourage you to produce routine billings on a weekly or bi-monthly basis. The Provider Direct Manual gives specific instructions on information needed to complete a claim form. The Provider Direct Manual is available on the portal.

Q. Can I file an appeal on behalf of my patient?

A. A provider may file an appeal on behalf of a member with the member’s written consent in accordance with 42 CFR 438.402. Cardinal Innovations will not prohibit or otherwise restrict a healthcare provider acting within the lawful scope of practice from advising or advocating on behalf of a member who is his or her patient.

Q. How can I help my patients confirm eligibility?

A. Individuals with IDD/MH/SUD who have Medicaid in our coverage areas are eligible for services. Our team confirms each person's health plan based on specific criteria. For more information, refer to the Members page.

Q. How quickly can I become a provider?

A. While we can't guarantee a specific turnaround time, it is our goal to process your application promptly.

Q. How is my application to the provider network processed?

A. Cardinal Innovations Network Operations and Cardinal Innovations Service Center process enrollment. These teams ensure that provider enrollment is in line with our mission. To read more about these groups, see the Our teams page.

Q. How and when will I receive funding?

A. If you are a non-hospital provider, you must submit claims for payments within a certain time frame. Submit claims within 90 calendar days to ensure payment, unless specified in your contract. Hospital claims and claims involving coordination of benefits (COB) must be received within 180 days of the service date. We will deny claims submitted outside of the allowable billing days. Claims are paid by electronic funds based on the check-write schedule. Review information regarding Electronic Funds Transfer (EFT) for details.

Q. How do I get a Provider Direct login?

A.  Review the list of tasks that are required in order to gain a Provider Direct login. You may also view the Provider Direct System Administrator Designee Form.

Q. What does Cardinal Innovations Healthcare help me provide to patients?

A. As a Cardinal Innovations provider, you're helping ensure care to our members with complex needs. Our core values shine through our providers' work and permeate everything they do.

 

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