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Welcome to the Cardinal Innovations Provider Network.

We will support you in any way we can to help you comply with and maintain your Network status going forward. Our ultimate goals are the provision of effective care for our members and timely reimbursement to you for such care – proactively maintaining your provider contract is fundamental to meeting these goals:

  • Read your provider contract and take note of the elements you are required to update with Cardinal Innovations over time.  Most importantly, please ensure that we have on file an up-to-date copy of your Certificates of Insurance and licensing at all times. These can be submitted to your Network Specialists or you can email them directly to Network Management at          networkmgt@cardinalinnovations.org.
  • If you wish to amend your contract to add sites and/or services that are on our Needs List, please submit an application to amend your contract and ensure that the amendment is fully processed prior to any dates of service for which you will seek reimbursement.  Bear in mind that, except for client-specific amendments that clinically require expedited treatment, Cardinal Innovations has 30 days to process your amendment requests. Additional Site/Service Applications >
     
  • If you wish to remove sites and/or services from you contract, please work with us to transition any member whose care will be affected prior to making the change. Your contract contains the timelines for notice of such changes. Your contract can be amended in these instances based on a Change/Update Request Form submitted to your Network Specialist. 

    • Other changes can be made on the basis of a Change/Update Request Form, without amending your contract. For instance, if you employ a clinician already credentialed with Cardinal Innovations and in good standing, the clinician can be associated to your contract based on the Change/Update Request Form. The Form can also be used to give notice of changes to mailing/billing addresses, or to identify contact personnel and new phone numbers.  Change/update form >

 

  • If you wish to work with relatives or legal guardians as direct support employees, Cardinal Innovations is here to help you with that process. Relative as Direct Support Employee >
  • As with any relationship, there may be times when you disagree with a decision that Cardinal Innovations makes in connection with your claims or your Network status. Cardinal Innovations has mechanisms in place for you to state your disagreement:
     
    • Billing or claims issues and denials within 120 days of the date of service that cannot be resolved in consultation with your claims specialist may be submitted by a request for Review and Determination. Provider Review & Determination Process
    • When a Provider receives notice of one of the decisions outlined below, the Provider has seven (7) calendar days to request Reconsideration of the action. 
      • Imposition of a payback for out of compliance areas
      • Imposition of a Plan of Correction
      • Imposition of a Referral Freeze
      • Terminations
      • A finding that the provider is out of compliance with Medicaid or Cardinal Innovations documentation requirements 

        Reconsideration Request Forms >