Ready to apply to join our network of providers? Review the options below to find the application best for you. Please note, in order to be reimbursed for services rendered to Cardinal Innovations members, providers must:
- Apply
- Be credentialed by Cardinal Innovations
- 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.
Licensed Independent Practitioner (LIP)/LIP Group Request for Contract Application
Licensed Independent Practitioners are both solo practitioners and practitioner groups. Review the Services Needs List to see what services your Solo LIP/LIP Group Practice can apply for.
If applying for SCS services, please see qualification requirements.
- Advanced Practice Psychiatric Clinical Nurse Specialists (PMHCNS-BC)
- Board-Certified Behavior Analysts (BCBA)
- Licensed Clinical Addiction Specialists (LCAS)
- Licensed Physician Assistants (PA)
- Licensed Clinician Mental Health Counselors (LCMHC)
- 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 (PMHNP-BC)
LIP/LIP Group request for a contract
Agency application
If your agency can provide services such as IDD/MH/SUD clinical or enhanced services, use this agency application.
If you’re applying for outpatient services only, please refer to the LIP/LIP Group application above.
- Licensed Alternative Family-Living providers (AFLs)
- Licensed facilities (i.e. Therapeutic Foster Care)
- Community-based services
- Day-program agencies
Agency application
Hospital application
If you represent a hospital and wish to contract as a network provider, apply with our hospital application.
View hospital application.
Non-contracted hospital or physician group application
Apply with the physician group application if you represent a:
- Physician or physician group and do not wish to contract as a network provider, but I seek payment for services.
- Hospital, and do not wish to contract as a network provider, but I seek payment for inpatient/ED services.
Physician group application.
Rendering practitioner for an existing contracted provider
The rendering practitioner credentialing form is for a rendering practioner who wishes to join our provider network.
Rendering practitioner credentialing registration form
In addition to the above selections, use the following to apply for specialty privileges to render the applicable service.
Individual Practitioner Application for Privileging to Render Sexual Harm Assessment Services for Children and Adolescents
Individual Practitioner Application for Privileging to Render Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Parent-Child Interaction Therapy (PCIT)
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 Cardinal Innovations
- 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.