​​​​New!  ​Introduction to Provider Basic Training


Claims Assistance​​ >
The presentation is a brief overview of the Cardinal Innovations Healthcare claims submission process including payments and denials. It provides links where additional claims information can be found as well as a FAQ link. Information regarding the Review and Determination process is also included.​​​

Clinical Operations Overview >
This presentation is designed to give a general overview of both the Cardinal Innovations Healthcare Access and Utilization Management Functions. This overview includes general information related to the submission of authorization requests, submission of plans and service specific information.

 

Care Coordination Overview (ID/DD) >
This presentation provides an overview of the fundamentals of Cardinal Innovations Healthcare care coordination for individuals with intellectual and developmental disabilities. It outlines the role of care coordination in a managed care organization and provides the criteria for identifying special needs populations, the core functions of care coordination, referral pathways to link individuals with direct care coordination intervention and care coordination interface with providers. Information related to monitoring requirements, as well as the duration of care coordination is also included. This presentation provides an overview of the fundamentals of Cardinal Innovations Healthcare mental health and substance use disorder care coordination. It outlines the role of care coordination in a managed care organization and provides the criteria for identifying special needs populations, the core functions of care coordinators and the referral pathways to link individuals with direct care coordination intervention. This presentation will also provide an overview of regional and corporate care coordination structure. This presentation highlights the regional structure of the Cardinal Innovations Healthcare Community Partners Department and its role in engagement, advocacy, education and customer service with consumers, family members, community members and stakeholders.

 

This presentation outlines what the Provider Procurement Contract says about sanctions and terminations. It includes information about the process and procedures by which Cardinal Innovations Healthcare makes the decision to sanction or terminate a provider in its network. 

 

This presentation addresses the onboarding process for providers successfully applying to participate in the Cardinal Innovations Healthcare provider network. The presentation describes the contracting process for LIP and Agency providers, as well as the credentialing process for their clinicians.​


This presentation describes when a provider's contract can be amended and how the amendment process works. Information about the rights and obligations of a Cardinal Innovations Healthcare Network Provider under its provider contract is included. ​

 

Relative as Provider (RDSE) Overview >
This presentation provides information on Cardinal Innovations Healthcare's "Relative as Direct Support Employee" Process, also known as "Relative as Provider."         

 

This presentation explains the process for requesting reconsideration of a Cardinal Innovations Healthcare action against a network provider. This presentation does not explain the method to request review of a claim denial or review of an authorization denial. 

 

Quality Management Overview >
This presentation provides an overview of the role of the Cardinal Innovations Healthcare Quality Management department. Summary guidelines for a successful provider monitoring review are provided. The NC provider monitoring process and other provider review descriptions are included in this presentation.​

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