We are redesigning our website to better serve you. If you can't find something, email us. close

We are redesigning our website to better serve our members, their families, our providers, and communities. If you can’t find what you’re looking for in this list, please contact your network specialist or email us.

Billing and claims

835 response file routing change form 
837I (institutional) companion guide 5010 
837P (professional) companion guide 5010
Active service list by category 
Authorization agreement for electronic transfer fund form 
Checkwrite schedule 2018
Checkwrite schedule 2017
​EFT instructions
Guide for psychological testing documentation/billing
HIPAA 276277 companion guide for batch transaction ​
Non-UCR invoice form 
Place of service crosswalk 
Rate table FY1718
Reason codes 
Refund check details form 
Replacement claim guidelines​ 
Review and determination (R&D) claims denial request form ​
SFY18 supplemental short-term assistance for group homes funding information with links to forms 
Sliding fee schedule (monthly income)
Sliding fee schedule​ (yearly income)

Capacity/accessibility study

2017 Triad region (formerly CenterPoint) needs assessment and gaps analysis
2017 community needs assessment and gaps analysis
2016 provider capacity, community needs assessment and gaps analysis

Change requests

File Transfer Protocol ("FTP") Access Change Form
Provider request for change/update
Provider request for change/update - to add an already credentialed practitioner
Taxonomy change/update form


Credentialing and enrollment

Additional site application
Additional service application
Policy and procedure review tool
Provider direct system administrator designee form
Review sheet for additional sites/service
Service needs list
Tasks required to obtain a Provider Direct login
Trading partner agreement - submission

Credentialing and enrollment – hospitals

Hospital-based inpatient and outpatient psychiatric services application
Inpatient/ED provider registration request form
Inpatient/ED provider registration request form – cover letter

Credentialing and enrollment – Licensed Independent Practitioners (LIPs)

Attestation statement
Cardinal Innovations initial registration form -- LIP (group or solo practice)
Individual practitioner application for privileging to render sexual harm assessment services for children and adolescents
LIP credentialing
Provider evaluation form


Credentialing and enrollment – new agencies

General Conditions of the Procurement Contract
New agency application request
Provider enrollment/amendment service need list

Cultural competence

Harvard program uses bicultural model of diagnosis
​Linguistic competence for large and small organizations​​
Cardinal Innovations Healthcare cultural competence plan 2016-2020
Cultural and linguistic competency assessment
Cultural Competence plan template​
Cultural competency review tool
New York State Psychiatric Institute - Center of Excellence for Cultural Competence reports and articles
Reducing language and cultural barriers​​
State law requirements on language access


Forms and general resources

Authorization guidelines
Calcium Calendars
Calcium Calendar - provider instructions
Calcium ​Calendar - request form
Complete TBI screening form
Contracted services/providers needed
Grants & special projects request
Mental health group living referral/screening form
MHSUD checklist for adult 
MHSUD checklist for child
Outpatient therapy submission tips
Provider Council FAQs
Provider directory
Provider Vacancy Announcement - IDD
Provider Vacancy Announcement - MH
Quality improvement activities report form
Regional Referral Form
Request for Reconsideration of an Action form
Residential Application​​​ - Child MHSUD/IDD - PDF Version
Residential Application​​​ - Child MHSUD/IDD - Word Version
Residential Application​​​ - Adult MH/SUD
​Standardiz​ed Financial Intake Form
System of Care review referral form
TAR: "How To" paper TAR example
TAR: Retro Medicaid paper TAR
UM clinical Q&A webinar FAQs
UM tips for submission of authorization requests 
Wraparound referral form

ICD-10 resources

Cardinal Innovations 2014 top 10 primary DX codes
CMS - The Road to ICD-10 from Healthcare Information and Management Systems Society (HIMSS)
Coding behavioral health services from National Council for Behavioral Health
FAQ - understanding Cardinal Innovations' ICD-10 compliance plans 
FAQ - understanding ICD-10 
General information about ICD-10 from NC Tracks
ICD 9 to ICD 10 crosswalk from NC Tracks
ICD-10 code set to replace ICD-9 from American Medical Association (AMA) provider resources
ICD-10 implementation from American Academy of Professional Coders (AAPC)
ICD-10 matters from American Health Information Management Association (AHIMA)
ICD-10 news from Workgroup for Electronic Data Interchange (WEDI)
ICD-10 training by position from American Academy of Professional Coders (AAPC)
ICD-10 webpage- countdown to compliance from Centers for Medicare and Medicaid Services (CMS)
ICD10WATCH News from Healthcare IT & Healthcare Finance ICD10WATCH
Mental, behavioral and neurodevelopmental disorders F01-F99 from ICD10 Data
Provider resources from Centers for Medicare & Medicaid Services (CMS)
Q&A about ICD-10 codes and crosswalk from NC Tracks
Road to 10: the small physician practice's route to ICD-10 from Centers for Medicare & Medicaid Services (CMS)


Individual and Family Directed Services (IFDS)

Agency with Choice Employer Handbook Supplement
American Red Cross Disaster Preparedness
Employer Form: Authorization to Disclose Healthcare Information
Employer Form: Description of Duties of Representative
Employer Form: Designation of Authorized Representative 
Employer Form: Direct Support Professional Agreement 
Employer Form: Emergency Plan Review Log
Employer Form: Emergency Telephone Numbers
Employer Form: Employee Job Description
Employer Form: Employee Performance Evaluation Example 1
Employer Form: Employee Performance Evaluation Example 2
Employer Form: Employee Support Agreement
Employer Form: Employer Self-Assessment
Employer Form: Employee Training Log
Employer Form: Employment Reference Worksheet
Employer Form: Financial Support Services Agreement 
Employer Form: Health and Safety Checklist for Services in Direct Service Employee Home
Employer Form: Hepatitis Employee Notification
Employer Form: Individual and Family Directed Supports Agreement: Employer of Record
Employer Form: Individual and Family Directed Supports Assessment: Employer of Record
Employer Form: Job Application for Prospective Employees
Employer Form: Notice of Unsatisfactory Performance
Employer Form: Out of State Travel Request Form
Employer Form: Personal Reference Worksheet
Employer Form: Reference Information Release
Employer Form: Release of Information to Cardinal Innovations

Employer Form: Request for Employee Training
Employer Form: Supervision Log
Employer Form: Telephone Screening Form 
Employer of Record Handbook Supplement
Employment Tips and Resources
Quality Management and reporting: Back Up Staffing Incident Form
Quality Management and reporting: Employee Qualifications Training Checklist
Quality Management and reporting: Plan of Correction Form
Quality Management and reporting: Quarterly Incident Report
Quality Management and reporting: Record Management Training Module
Training Employees: Positive Supports Training Cover Letter
Training Employees: EOR Positive Behavioral Supports Training
Training: IFDS 2017 Module 1 - Why Community Navigator is so Important
Training: IFDS 2017 Module 2 - How to Teach the Orientation
Training: IFDS 2017 Module 3 - Employer of Record
Training: IFDS 2017 Module 4 - Agency with Choice (AWC) Model
Training: IFDS 2017 Module 5 Part 1 - General Employment and Requirements
Individual and Family Directed Supports Employer Handbook
Understanding Self-Directed Services

Manuals and guidelines

Clinical design plan
Plan administration guide: state-funded member financial eligibility criteria
Practice guidelines overview
Provider manual


NC MH/DD/SAS health plan - (b)(3) Services

Overview of (b)(3) medicaid services 
​(b)(3) Innovations deinstitutionalization service array ​
​(b)(3) psychiatric consultation adults and children 
​(b)(3) transitional living adolescents MH/SA adults MH/SA 
(b)(3) community guide children and adults with intellectual/developmental disabilities 
(b)(3) individual support men​tal health adults 
(b)(3) in-ho​me skill building children and adults with intellectual/developmental disabilities
(b)(3) intensive recovery supports women with SUD 
(b)(3) peer support services 
(b)(3) respite children (MH/IDD/SA) and adults with developmental disabilities 
(b)(3) supported employment adolescents and adults with intellectual/developmental disabilities medicaid billable 
(b)(3) supported employment members with serious​ mental illness Medicaid-billable 
Tips for plans for supported employment

Peer support

A recovery culture progress report​
National guidelines
Peer support brochure
RAS evaluation
Recovery assessment scale


Provider review and determination process

Review and determination (R&D) authorization issue request form 
Review and determination (R&D) claims denial request form​ ​​


Quality Management resources

Block Grant Monitoring Readiness Review Tool (Monitoring Only)
Block Grant Monitoring Readiness Review Tool (Record Review Only)
Completing Internal Record Audits and Reviews
DHHS Restrictive Intervention Details Report - Form
Guidance for Comprehensive Clinical Assessments (CCAs)
Improve Provider Monitoring Review Outcomes with These Tips
Incident and Death Reporting Form
NC Innovations Incident Report for Failure to Provide Back-Up Staffing Form
Provider Quarterly Incidents Report Form - In Catchment Only

Relative as Direct Support Employee (R.D.S.E.)


For requests of 41 to 56 hours per week: Relative as Direct Support Employee (R.D.S.E.) application
For requests of 40 hours or less per week: report each relative/legal guardian
RDSE Innovations tips
RDSE provider training
RDSE application Part D


State resources

Medicaid bulletins page of DMA
North Carolina state records management and documentation manual
North Carolina Incident Response Improvement System (IRIS)
North Carolina IRIS Resources



DirectCourse/College of Direct Supports brochure
DirectCourse College of Direct Supports website


Transition to community living

Community, friends, jobs handout​
NC Department of Human Services transitions to community living initiative 
TCL - frequently-asked questions 
U.S. Department of Justice settlement agreement with NC DHHS​ 


Waiver and I/DD

Hard Limits - benchmarks for providers and families​
ICF provider instructions
ICF Level of Care Form
IDD Service Referral Form
IDD Provider Reporting Spreadsheet
NC Innovations ISP checklist


Contact information

Accessing the secure messaging portal
Send/receive secure emails 


ICD-10 questions

Network Management

Quality Management

Regional community offices

Service Center and finance claims

Website help

Join our member newsletter