1915(b)(c) Waiver Renewal - public comment open through November 22 and 28, 2018 close
Ensuring our members receive the highest quality and most appropriate care possible starts with a strong network of providers. We are committed to supporting providers, making it simple and easy for you to maintain your network status and work with us. We are also committed to your business, and have a dedicated team of claims specialists to ensure timely, accurate claims processing and payment.

Our teams of clinical specialists and local network representatives understand your market and business, and will work with you to ensure your needs are being met. On this page you will find resources to help you navigate the system and remain in good standing.

To best serve all current and potential members, we require priority admission for all women who are pregnant and injecting drugs, women who are pregnant and using substances, and for other individuals who are injecting drugs.

Billing & claims

We value our network providers and recognize the importance of paying claims in an accurate and timely manner. Our Provider Direct system allows you to submit claims, check claims status, submit authorizations, and more.
 

Resources

For help with Provider Direct, use the Feedback button on the far right of the Provider Direct menu when logged in or call our Provider Line at 1-855-270-3327.  

For help with claims, you can call the Provider Line at 1-855-270-3327 or email claims@cardinalinnovations.org.

Review and determination information can be found in the Provider Manual and related materials can be found in the Resource library.

For more billing and claims resources, visit our Resource library.
 

Contracting

It is important that your basic information, including site locations, service offerings, staff listings, and contact information, is kept up-to-date.

To make demographic changes like these that do not require an amendment, please update your information in our system by completing this form and emailing it to your assigned Network Specialist.  If you do not find your agency’s name on the list, please contact the Network Supervisor or Regional Network Manager assigned to the location of your North Carolina corporate address.

If you’re interested in adding a service or a site to your contract, please review our Service Needs List and contact your Assigned Network Specialist to discuss.  If you do not have an Assigned Network Specialist, or are unable to reach them, you may contact the Network Supervisor in your region, found on the list.

Your ability to fill a need on this list does not guarantee a contract with our network and the right to extend or approve applications for enrollment, additional sites, or additional services is at our discretion. In some instances, we may look to our existing network providers to render services identified on the Service Needs List before opening our network to non-contracted entities.

 

Resources

Find your assigned Network Specialist contact information or call our Provider Line at 1-855-270-3327.

HCBS information in the resource library.

Policy and Procedure Review Tool

Provider Request for Change/Update

Request for Change/Update to add an already Credentialed Practitioner

Review Sheet for Additional Sites/Service

Service Needs List

Taxonomy Change/Update Form

For more contracting resources, visit our Resource library.
 

Out of network

Any provider entity that does not have an active written Procurement Contract with us is not considered as being in our provider network. These are commonly referred to as “out of network” providers. In certain cases, we may work with out of network providers through arrangements other than a standard network contract. There are two types of out of network providers we work with – non-contracted providers and those that render services under member specific agreements.

Non-contracted providers
Providers such as hospital Emergency Departments and Emergency Department Clinicians or Clinician Groups may be paid on a non-contracted basis.

A hospital may choose to be listed in our system as a “non-contracted hospital biller” to process claims for inpatient or emergency department services more easily. However, these providers will not be listed as choices for inpatient care for our members and are not considered a part of our Provider Network.

Non-contracted hospitals may not use this process to obtain reimbursement for claims for outpatient, enhanced or residential services.

Member Specific Agreements
While we prefer that our members use providers and sites in our network when those providers are available and able to meet their clinical needs, we acknowledge that exceptional situations occur and other arrangements may be needed in order to meet some members’ needs. We do this through Member-Specific Agreements (MSAs). These were formerly called “client-specific agreements”. Out-of-Network providers that receive member-specific agreements are not considered part of our Provider Network and are not offered as a preferred choice to our members.

In order to contract with us on a member-specific basis, all information requested in the Out of Network Member Specific Agreement must be provided. Speak with a member of our Network Management team to discuss more 1-855-270-3327 or email NetworkMgt@cardinalinnovations.org.

NC Tracks
NC Tracks is the statewide 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.
 

Resources

For more resources, visit our Resource library.

To speak with a member of our team, call our Provider Line at 1-855-270-3327 or email NetworkMgt@cardinalinnovations.org.

Compliance

As a contracted provider, we are responsible for ensuring you are compliant with certain contractual, state, and federal regulations.

Accreditation
Providers are expected to meet all the accreditation requirements for all services provided.

Federal block grants
We hold annual training sessions for providers receiving federal monies. Contracted providers with a designated funding authorization (DFA) in support of these monies are strongly encouraged to attend the training. These trainings cover the deliverable associated with various funding streams and providers are supplied with the most recent audit tools related to those streams.

Grants & Special Projects
Providers and community stakeholders who are looking for a letter of support from Cardinal Innovations, must submit an online request. This request can be made by the provider or community stakeholder or by one of our employees on their behalf.

After the request is received, our internal Grants and Special Projects Committee reviews the request and supporting documentation. We ask for 15 business days to review.

Notices of acceptance or rejection will be sent by email. If a request is approved, a formal letter of support will be attached to the email and also sent by first class mail. A letter of support does not guarantee contracting or any other benefit or service from Cardinal Innovations.

Insurance
All contracted providers are required to purchase and maintain insurance. A certificate of insurance (COI) is required to remain a member of our Provider Network.

Every month, our team will send an email reminder to providers who have insurance expiring soon. Technical assistance is available by emailing networkcompliance@cardinalinnovations.org.

Insurance requirements are outlined in your contract.

Licensure
As a contracted provider in our network, it is your responsibility to ensure that all clinicians are appropriately licensed, and that your sites are licensed to the extent required by DHSR or DSS. Providers should refer to your contract to ensure compliance.

NC TOPPS
NC Treatment Outcomes and Program Performance System (NC-TOPPS) is a web-based program owned by the NC Department of Health and Human Services (NC DHHS). This program gathers outcome and performance data on mental health and substance use disorder services in North Carolina’s public system of care. NC-TOPPS collects information that is used to measure the impact of treatment and to improve service and manage quality throughout the service system.

Priority Admissions
We require our providers to give priority admission for all women who are pregnant and injecting drugs, women who are pregnant and using substances, and for other individuals who are injecting drugs.

Provider Reconsideration
Providers can request reconsideration of certain actions, including:

  • imposition of a payback for areas of non-compliance
  • imposition of a Plan of Correction
  • imposition of a Referral Freeze
  • termination of provider’s contract
  • finding that the provider is out of compliance with Medicaid or Cardinal Innovations documentation requirements
  • decision to suspend payments
  • decision to remove sites and/or services from the provider’s contract
If a provider receives notice of an action mentioned above, the provider has 10 business days from notification to request a reconsideration.

Requests for reconsideration are reviewed by our Reconsideration Committee at a regularly scheduled meeting after all necessary documentation has been submitted.

Our standard timeframe for a decision is 60 days, but the Reconsideration Committee may extend the time up to an additional 30 days. If the Reconsideration Committee chooses to extend this timeframe, the provider will be notified in writing and may be allowed to submit additional information during this time. After a decision has been made, the provider will be notified in writing.

More information about this process is provided in the Provider Manual.
 

Resources

If you have questions about these requirements, contact your Network Specialist.

For more compliance resources, visit our Resource library.
 

Additional Information

Calcium Calendars
This web-based calendar is for providers to add and maintain available appointments. Contracted providers may access this calendar by logging in to Provider Direct.

Capacity Study
Capacity/Accessibility Study is our annual assessment of our communities to determine needs and the capacity of available providers to deliver services. This comprehensive evaluation helps us in the development of organizational strategies such as local business plans, network development plans, and other strategic initiatives that may be needed based on the results.

Communication Bulletins
Provider Communication Bulletins are formal communications from Cardinal Innovations to our network of providers as changes or new developments occur throughout the year. Communication Bulletins are incorporated into your contract by reference and are therefore deemed part of your contract.

Committees & Councils
Our committees and councils are groups of members, families, providers, community stakeholders, and employees who are passionate about protecting the wellness of the people we support.

More information is available on our Committees & councils page.

Cultural Competence
We are committed to fostering an environment that is safe and inclusive for our members, providers, community stakeholders, and employees. Building that environment with the support of our provider network is key to the success of our members and communities we serve.

Providers can get involved by participating in the Cultural Competence Provider Council (CCPC), in available training events, and reviewing the resources available.

Direct Support Professionals
A Direct Support Professional (DSP) assists individuals with disabilities, providing assistance with daily living activities if needed and supporting behaviors that enhance community inclusion. Providers in our network can access free, specialized online training specifically for DSPs who serve members with intellectual and developmental disabilities (IDD) with DirectCourse training.

Read this informational packet with a course listing, helpful information, and cross-walks to both the HCBS Final Rule Requirements and CMS Core Competencies.

To sign-up to use DirectCourse, network provider agencies should contact Kimberly Knotts, System Administrator, at 1-704-986-7291 or by email at Kimberly.knotts@monarchnc.org.

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 to they can contract for those services.  More information about HCBS can be found in the resource library.

InfoSource
InfoSource is our email newsletter sent weekly to our provider network. Don’t miss the latest information, events, and announcements by registering your email address.

Provider Direct
Provider Direct is your online resource to make sure members get the appropriate care. Through this portal you can:

  • Enroll new members
  • Update clinical documentation
  • Create treatment authorization requests
  • View claims
  • Submit claims
  • View client information
  • Access training and instructional videos
For help with Provider Direct, use the Feedback button on the far right of the Provider Direct menu or call 1-855-270-3327.

Practice guidelines
Practice guidelines are intended to:
  • improve care
  • assist providers and members in clinical decision-making
  • document evidence available to determine appropriate care
Guidelines are not meant to dictate clinical practice but are a good resource for guidance in the care of the members we serve. Each member is an individual with unique needs and each provider has their own approach to delivery of care. Therefore, all treatment should be individualized. Good clinical judgment should be used in all situations and at times will supersede practice guidelines.

More information can be found in the Resource library.

Provider Manual
The Provider Manual begins with Cardinal Innovations’ mission, vision and core values. It describes our policies and procedures—from referrals and authorizations to claims submission and problem resolution. We have also included a glossary of frequently used terms for your reference and links to all necessary forms. Your adherence to these guidelines will assist us in providing you with timely service authorizations and claims reimbursement.

The Provider Manual can be found in the Resource library.    
                                              
Relative as Direct Support Employee (“RDSE”)
The RDSE process is a NC Innovations Waiver policy that is based on North Carolina’s application of federal requirements regarding the employment of relatives to provide the NC Innovations Waiver service of Community Living and Support. Providers, Agencies with Choice, and Employers of Record (providers) must be able to verify compliance with this NC Innovations Waiver policy.
  • For requests to employ a relative (new or renewal) for 40 hours or less per week, click here.
  • For requests to employ a relative (new or renewal) for 41 to 56 hours per week, click here.
For more RDSE resources, visit our Resource library.

Resources
For more provider resources, visit our Resource library.

Training information
Information about future available training can be found in The Learning Center. Need help accessing The Learning Center? Click here.

We also add many trainings, meetings, and community events to our Events calendar.

When available, past training materials will be available in our Resource library or in our FAQs.
 

Contact Information


Find your Assigned Network Specialist.

To speak with a member of our team, call our Provider Line at 1-855-270-3327 or email NetworkMgt@cardinalinnovations.org.

To contact our Service Center or Finance team, click here.

You can contact our Quality Management department or email the team directly at QMemail@cardinalinnovations.org.

We take concerns and complaints seriously. You can express your concerns about Cardinal Innovations or report suspected fraud and abuse.

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