Author: NC HIEA, 919-754-6912
One of the goals of a transformed health care system is for real-time clinical and demographic data to be made available to all health care providers involved in a patient’s care so that they can securely share health information concerning that patient with each other. North Carolina health care providers are required by law to connect with NC HealthConnex, North Carolina’s designated health information exchange, by specific deadlines:
- June 1, 2018. Hospitals as defined by G.S. 131E-176(13), physicians licensed to practice under Article 1 of Chapter 90 of the General Statutes, physician assistants as defined in 21 NCAC 32S .0201, and nurse practitioners as defined in 21 NCAC 36 .0801 who provide Medicaid services and who have an electronic health record system.
- June 1, 2019. All other providers of Medicaid and state-funded services except dentists, ambulatory surgical centers and pharmacies.
- Early 2019. Prepaid Health Plans (PHPs), as defined in S.L. 2015-245 as amended, will be required to connect to the HIE per their contracts with the NC Department of Health and Human Services (NCDHHS). PHPs will be required to submit encounter and claims data by the commencement of the contract with NCDHHS.
- June 1, 2020. Local Management Entities/Managed Care Organizations (LMEs/MCOs) will be required to submit encounter and claims data.
- June 1, 2021. Dentists and ambulatory surgical centers will be required to submit clinical and demographic data (NCSL 2018-41). Pharmacies will be required to submit claims data once per day, using pharmacy industry standardized formats.
Important Note for Health Care Providers Who Did Not Connect by June 1, 2018
Hospitals, physicians, physician assistants and nurse practitioners, as described above, who did not start the connection process by June 1, 2018, are not in compliance with state law. NC Medicaid will work collaboratively with these providers to bring them into compliance, including issuing corrective action plans. At this time, noncompliant providers will continue to be enrolled in NC Medicaid and, as they file claims, will receive reimbursements for services and treatment of NC Medicaid beneficiaries.
What Does "Connected" Mean?
To meet the state’s mandate, a Medicaid provider is "connected" when its clinical and demographic information pertaining to services paid for by Medicaid and other State-funded health care funds are being sent to NC HealthConnex, at least twice daily—either through a direct connection or via a hub (i.e., a larger system with which it participates, another regional HIE with which it participates or an EHR vendor). Participation agreements signed with the designated entity would need to list all affiliate connections.
The North Carolina Health Information Exchange Authority (HIEA), the state agency managing NC HealthConnex, and NC Medicaid appreciate the many providers who have initiated a connection and are making data available through the system. Medicaid and the HIEA will continue to work closely together to ensure that NC HealthConnex develops to support health care providers and enables all of us to better serve patients and families.
To start the connection process, providers can call HIEA at the number below. Sign up here to be placed on the HIEA’s distribution list for monthly updates.