Clinical Operations

Cardinal Innovations' Clinical Operations Department consists of three units: Access, Clinical Support and Utilization Management. Evidence of Cardinal Innovations' clinical expertise begins the moment an individual is enrolled, making sure the best services are available, linking members to those services and monitoring service delivery to fulfill the individual's needs. The department plays an integral part in the coordination and management of mental health, intellectual and developmental disability and substance use disorder services for our members across the state.  Staff is based locally to better assist members and connect them to the appropriate level of high quality care.

Within Clinical Support, an Enrollment and Eligibility team is responsible for:

  • ​Checking member eligibilit
  • Reviewing and approving provider submitted enrollment
  • Maintaining IRPS Compliance
  • Monitoring NCTOPP
  • Ensuring data integrity related to Target Populations
  • Researching Medicaid loss reports, missing data reports and duplicate client reports
  • Coordinating research on claim kick outs and denials and ensuring that corrections are submitted

​Cardinal Innovations is responsible for a timely response to member needs and for quickly linking members to qualified providers in the network. To ensure that the system remains simple–as requested by members and stakeholders–Cardinal Innovations Access Department maintains a toll-free/24-hour call system to receive all inquiries.

The Access Department is a critical function of Cardinal Innovations Healthcare. The Access referral line, 1-800-939-5911, is available 24 hours a day, 7 days a week, 365 days a year for assessments via telephone, crisis intervention, and authorization requests for people seeking assistance with mental health, substance use disorder, and intellectual and developmental disability issues. 

The Clinical Operations Department developed a broad Clinical Design Plan, which outlines Cardinal Innovations' approach to providing high quality and highly accessible services for its members.

The plan outlines the clinical design structure for our North Carolina Medicaid Cardinal and Innovations Waiver Health Plans. It was developed by Cardinal Innovations' clinicians under the direction of our Chief Clinical Officer and Medical Director Dr. Keith McCoy, as well as our Clinical Directors and Vice President of Clinical Operations. Input and oversight was provided by Cardinal Innovations' Clinical Advisory Committee, which consists of experts in the behavioral health field from Cardinal Innovations as well as from several universities and health organizations.