Types of providers
Our provider network is a passionate group of professionals. Experts in diverse areas of care, they work with us to create a support system for our members and their families. Providers in our network falls into one of these groups:
Agencies offer one or more IDD/MH/SUD clinical or enhanced services. Examples:
- Alternative Family-Living providers (AFLs)
- Comprehensive Community Clinics (CCC)
- Clinical Homes for Members
- Day program agencies
- Therapeutic foster care
Hospitals are facility-based providers that provide inpatient, outpatient, and/or emergency services. They are licensed by the
Department of Health Service Regulation and accredited by the
Joint Commission.
Licensed Independent Practitioners (LIPs) are both solo providers and groups. Examples include but aren’t limited to:
- Advanced Practice Psychiatric Clinical Nurse Specialists
- Board-Certified Behavior Analysts
- Licensed Clinical Addiction Specialists (LCAS)
- Licensed Marriage and Family Therapists (LMFT)
- Licensed Physician Assistants (PA)
- Licensed Professional Counselors (LPC)
- Licensed Psychological Associates (LPA-Master’s Level Psychologists)
- Master’s Level Social Workers (LCSW)
- Medical Doctors (MD)
- Practicing Psychologists (PhD and PsyD)
- Psychiatric Nurse Practitioners
Our contracted providers deliver care to our North Carolina members who reside in Alamance, Cabarrus, Caswell, Chatham, Davidson, Davie, Forsyth, Franklin, Granville, Halifax, Mecklenburg, Orange, Rockingham, Person, Rowan, Stanly, Stokes, Union, Vance and Warren counties.
For more information, please refer to our
provider manual.
Service needs
We accept provider applications based on the services our members need. We find areas of need through capacity studies and regional research. Our published Service Needs List does not guarantee an offer to contract with new providers, or to add new sites or services to existing provider contracts.
Where am I needed? View the Service Needs List.
Applications
In order to be reimbursed for services rendered to Cardinal Innovations’ members, providers must:
- apply
- be credentialed by Cardinal Innovations
- and be enrolled in NC Tracks
Once credentialed, providers are required to have their credentials reviewed, verified, and reapproved at a minimum of every 36 months from the date of the last credentialing review.
Agency application
If all of the following pertain to you, apply as an agency.
- My agency is not contracted in the Cardinal Innovations provider network
- My agency can provide services on the Services Needs List and the services are defined as enhanced services
View request for agency application.
Hospital application
If ANY of the following pertains to you, apply as a hospital.
- I represent a hospital and I wish to contract as a network provider.
View hospital application.
Non-contracted hospital or physician group application
If ANY of the following pertains to you, apply as a hospital or physician group.
- I represent a physician or physician group and do not wish to contract as a network provider, but I seek payment for services.
- I represent a hospital, and do not wish to contract as a network provider, but I seek payment for inpatient/ED services.
View physician group application.
Licensed Independent Practitioner (LIP)/LIP Group Request for Contract Application
If ANY of the following pertain to you, apply as an LIP.
- I wish to join the provider network as a new contracted LIP solo practitioner.
- I wish to join the provider network within a new contracted LIP group
View LIP/LIP Group Request for a Contract Application.
Rendering practitioner for an existing contracted provider
If the following pertains to you, apply as a rendering practitioner.
- I wish to join the provider network as a rendering practitioner for an existing contracted network provider.
View the rendering practitioner Credentialing Registration Form.
In addition to the above selections, use the following to apply for specialty privileges to render the applicable service.
Member Specific Agreement (MSA)
In order to contract with Cardinal Innovations on a member-specific basis, a provider:
- must not currently have a Procurement Contract with us
- must be located outside of our 20 county catchment area
- must not serve more than two of our members
View more information on Member Specific Agreements.
NC Tracks
NC Tracks is the multi-payer Medicaid Management Information System used by the N.C. Department of Health and Human Services (NC DHHS). All contracted and out of network providers must
enroll with NC Tracks to receive payment.
Home and Community Based Services
Providers who have services that fall under the purview of the
Home and Community Based Services (HCBS) rule must meet that rule’s requirement for full integration so they can contract for those services.
More information about HCBS can be found in the
resource library.
Credentialing & enrollment
We enroll providers into our network who provide a high quality of care and use safe, ethical, and responsible best practices to achieve positive clinical outcomes for our members. Our providers must plan services and supports with the individual's unique needs, culture, and environment in mind. We monitor the quality of care provided to our members on an ongoing basis.
Enrollment information for agencies, hospitals, and Licensed Independent Practitioners (LIPs) can be found in our Resource library.
After going through the application and credentialing process and being selected to join our network of providers a provider Procurement Contract is developed to complete the enrollment process.
More information can be found in the Resource library or on our page about working with us.
Additional information
Getting set up
Provider Direct is your online resource to make sure members get the appropriate care. Getting set up with the Provider Direct portal includes reviewing the tasks required to obtain a login and then completing a quick form to assign a System Administrator.
Our Trading Partner Agreement can be reviewed and signed online.
InfoSource
InfoSource is our email newsletter sent to our provider network. Don’t miss the latest information about important matters, including contracting and service requirements, events, and announcements by registering your email address.
Communication bulletins
Find the latest announcements for providers from InfoSource. Explore updates for our provider network about utilization management, network management, quality management, finance, and more.
Contact information
To speak with a member of our team, call our Provider Line at 1-855-270-3327 or email NetworkMgt@cardinalinnovations.org.
We take concerns and complaints seriously. You can express your concerns about Cardinal Innovations or report suspected fraud and abuse.