North Carolina Medicaid and State Health Plan Payments at Risk
In 2015, the North Carolina legislature passed a law (GS 90-414.4) that requires North Carolina providers to participate in the NC Health Information Exchange, now known as NC HealthConnex. By February 1, 2018, all NC Medicaid providers must be connected and submitting data to NC HealthConnex in order to continue receiving Medicaid payments for services provided. By June 1, 2018, the same is true for providers who receive state funds from other programs, such as the NC State Employee Health Plan.
Full participation in NC HealthConnex will also allow you to query the Information Exchange, view, and download clinical and demographic information about your patients based on information submitted by other NC providers and hospitals. There are currently 855 NC facilities (hospitals, health departments, FQHCs and ambulatory practices) regularly submitting data to the Exchange. NCHealthConnex will eventually be connected to other Statewide Health Information Exchanges and federal agencies such as the Veterans Administration.
Data submission will occur electronically through an HL7 interface from your Certified EHR system to NC HealthConnex. There is currently no charge from NC HealthConnex to submit or access data; however, most EHR vendors will charge for an interface.
In order to meet the current timeframes, we recommend that all impacted NC providers begin the process as soon as possible. You’ll need to sign a participation agreement with NC HealthConnex and contact your EHR vendor to get started.
For more information, visit the NC Health Information Exchange Website.