The N.C. Health Information Exchange Authority is providing information about legislative requirements that is accurate to the best of our knowledge. Health care organizations and providers should continue to monitor changes to relevant laws implemented by the N.C. General Assembly, which supersede any information from the NC HIEA.
Last updated Feb. 27, 2023
A health information exchange is a secure electronic network that gives authorized health care providers the ability to access and share patient information across a statewide information network. It improves health care quality, enhances patient safety, improves health outcomes and reduces overall health care costs by making health information available to participating health care providers.
The North Carolina General Assembly created the N.C. Health Information Exchange Authority to oversee and administer the state-designated health information exchange (NCGS § 90-414.7). NC HIEA receives input and advice from its Advisory Board, which consists of patients, hospital personnel, physicians, technology experts, public health officials and other key stakeholders to continuously improve the health information exchange network, now called NC HealthConnex, and to move toward more efficient and effective care.
NC HealthConnex is a secure electronic network that facilitates conversations between health care providers, allowing them to access and share health-related information across the state.
Created by the North Carolina General Assembly (NCGS § 90-414.1 et seq.), NC HealthConnex is the state-designated health information exchange. It is managed by the N.C. Health Information Exchange Authority, housed within the N.C. Department of Information Technology.
The Statewide Health Information Exchange Act is found in Article 29B of Chapter 90 of North Carolina's general statutes. It established the N.C. Health Information Exchange Authority within the N.C. Department of Information Technology in 2015. The HIE Act requires that all health care organizations that receive state funds for the provision of health services, including local management entities and managed care organizations, submit demographic and clinical information pertaining to services rendered to Medicaid and other state-funded health care program beneficiaries and paid for with Medicaid or other state health care funds to the network (N.C. General Statute 90-414.4). The HIE Act provides for the mandated submission of clinical and demographic data from health care providers, but it also allows for the voluntary exchange of patient data if providers choose to send clinical and demographic data pertaining to services paid for with non-state funds.
The purpose of the Statewide Health Information Exchange Act is to improve the quality of health care delivery within the state by facilitating and regulating the use of a voluntary, statewide health information exchange network for the secure electronic transmission of individually identifiable health information among health care providers, health plans and health care clearinghouses in a manner consistent with the Health Insurance Portability and Accountability Act, Privacy Rule and Security Rule, 45 C.F.R. §§ 160, 164.
The connection of health care facilities to the state HIE, NC HealthConnex, is expected to help control costs for Medicaid and other state-funded health care services by providing authorized users with timely access to information on services paid for with state funds. This access can enable, for example, assessing performance, tracking medical expense trends, and evaluating the use of state funds. Moreover, the secure electronic availability of demographic and clinical information to the state and HIE participants can improve care coordination and quality, enable more effective population health management and syndromic surveillance, and support whole-person care, among other potential beneficial outcomes.
The establishment of the HIE also helps serve the purposes of An Act to Transform and Reorganize North Carolina's Medicaid and N.C. Health Choice Programs, which the North Carolina General Assembly enacted in 2015 to transition the state's Medicaid program from a fee-for-service model into a value-based managed care model (N.C. Session Law 2015-245). Value-based managed care requires that program administrators be given access to patients’ clinical information in addition to medical claims data to align payments to patient outcomes, coordinate care across disparate provider settings and reduce duplication of services across the health care continuum).
The Statewide Health Information Exchange Act and the 2022 Appropriations Act stipulate that certain health care organizations that receive state funds for treating Medicaid recipients and State Health Plan patients must connect to NC HealthConnex and begin submitting required data by January 1, 2023. The original statutory deadline set by the HIE Act in 2015 has been amended several times by the General Assembly, including extensions to allow organizations to handle pandemic-related disruptions.
At this time an organization that signs a Participation Agreement but is not yet live and submitting data by the January 1, 2023, connection deadline is considered to be making good faith efforts to connect.
Note that the condition of payment written in statute, which requires health care organizations that receive state funds (e.g., Medicaid, State Health Plan, etc.) for treating patients to connect in order to receive payments, has been suspended until such time that an entity is named to enforce the HIE Act. A report on which health care organizations have or have not connected to NC HealthConnex will be submitted to the N.C. General Assembly in March 2023. You may want to contact your attorney if you are unsure if your practice is required to meet the mandate to connect.
Unless otherwise classified as “voluntary” connections in the HIE Act, all health care providers who receive state funds for the provision of health care services to state-funded patients must connect to NC HealthConnex to continue to receive payments for services provided. State-funded healthcare includes, among other programs, Medicaid, the State Health Plan for Teachers and State Employees, certain grant-funded programs through the N.C. Office of Rural Health, adult corrections, and others. No single state agency maintains a list of all such programs and providers.
The HIE Act specifically identifies that these provider types are subject to the January 1, 2023, deadline to connect and submit certain data to the State via NC HealthConnex.
- All health care providers who receive state funds for the provision of health care services must submit demographic and clinical data.
- Ambulatory surgical centers, dentists, licensed physicians whose primary area of practice is psychiatry, and the State Laboratory of Public Health operated by the Department of Health and Human Services must submit demographic and clinical data.
- Pharmacies and state health care facilities operating under the jurisdiction of the secretary of the N.C. Department of Health and Human Services must submit claims data.
Certain provider groups faced earlier deadlines to connect and submit the required data to NC HealthConnex:
- Hospitals, physicians, physician assistants and nurse practitioners who provide Medicaid services and who have an electronic health record system
- Local management entities/managed care organizations
- Prepaid health plans with contracts with the N.C. Division of Health Benefits to deliver Medicaid and NC Health Choice
By law, certain provider types are classified “voluntary” providers. See N.C. Gen. Stat. 90-414.4(e). These voluntary providers may still elect to join NC HealthConnex. Providers may choose to execute a full participation agreement with the NC HIEA and gain to the benefits of the full suite of value-added NC HealthConnex services.
The presence of a voluntary provider within a health care organization does not mean that connecting is voluntary for the entire organization. Such organizations still need to connect by the Jan. 1, 2023, deadline.
The types of providers classified in statute as “voluntary” include:
- Community-based long-term services and supports providers (e.g., personal care services, private duty nursing, home health and hospice care providers)
- Intellectual and developmental disability services and supports providers (e.g., day supports, supported living providers)
- Community alternatives program waiver services (e.g., CAP/DA, CAP/C and Innovations)
- Eye and vision services providers
- Speech, language and hearing services provider.
- Occupational and physical therapy providers
- Durable medical equipment providers
- Nonemergency medical transportation service providers
- Ambulance providers (e.g., emergency medical transportation service)
- Local education agencies and school-based health providers
- Chiropractors licensed under Article 8 of this Chapter.
A health care provider is considered “connected” when its clinical and demographic information pertaining to services paid for by Medicaid and other state health care funds are sent daily to NC HealthConnex. This transmission of information may be through a direct connection to NC HealthConnex or through an indirect connection, such as through another heath information exchange, electronic health records vendor or a similar affiliate. Participation agreements must provide details of indirect connections through other entities, such as Mission Health’s heath information exchange.
State law requires that pharmacies registered with the North Carolina Board of Pharmacy be connected to the HIE Network and begin submitting claims data by January 1, 2023. If you are unsure whether your pharmacy is registered, you can contact the N.C. Board of Pharmacy.
The HIE Act has a requirement – now suspended – that as a condition of receiving state funds, pharmacies are to submit, at a minimum, claims data for all services for patients in Medicaid, State Health Plan and other state-funded health care programs. Pharmacies may also submit more data from patient records to help improve the overall quality and comprehensiveness of medical data in the state HIE network.
The NC HIEA is launching a pilot to integrate pharmacy claims data with the clinical records in the statewide HIE. This effort is one of the first of its kind nationally – to aggregate dispense data with clinical data to provide a more complete health record for North Carolinians at the point of care. Both large retail pharmacies and smaller independent pharmacies are participating in the pilot. The NC HIEA worked collaboratively with pharmacy stakeholders and the National Council for Prescription Drug Programs (NCPDP) to develop technical specifications that will be utilized and finalized in the pilot projects.
Because the pilot remains in progress, the NC HIEA views pharmacies that have signed participation agreements as acting in good faith to meet the January 1, 2023, deadline.
Dentists that serve state-funded patients remain subject to the January 1, 2023, connection and submission deadline. Enforcement of the “condition of receiving state funds” provision in the Statewide Health Information Exchange Act is temporarily suspended with respect to all providers, including dentists. Chiropractors have been added to the list of voluntary providers since the North Carolina Regulatory Reform Act (N.C.S.L. § 2023-137) became law in 2023 and expanded the list of providers who are no longer required to connect to NC HealthConnex to include chiropractors.
Generally, individual providers who are employed by an organization do not have to initiate or carry out the connection process themselves. The NC HIEA engages in participation agreements with organizations, and employed providers are covered under those agreements. The appropriate contact(s) at your organization(s) should visit hiea.nc.gov/participate to select the agreement suitable to the organization, and then carefully read, review, and complete the agreement. It may be returned either by email to firstname.lastname@example.org (preferred method) or by mail to N.C. Health Information Exchange Authority Mail Service Center 4101 Raleigh, NC 27699-4101.
The Health Insurance Portability and Accountability Act and the U.S. Department of Health and Human Services contemplate such exchange of health information. Health care providers and other covered entities are permitted to voluntarily share patient data with business associates, including health information organizations such as NC HealthConnex. See the definition of “business associate” in 45 C.F.R. § 160.103, which includes health information organizations; also see 45 C.F.R. § 164.502(a);(e)(1). HIPAA also recognizes that the disclosure of protected health information may be required by law and does not limit what amount of data should be exchanged in that circumstance (45 C.F.R. § 164.512 and 164.502(b)(2)(v)).
In addition, if disclosure of protected health information is required by law, providers do not have to seek authorization from the patient before making such a disclosure (45 C.F.R. § 164.512). Furthermore, covered entities may seek but are not required to obtain patient consent for disclosures made for the purposes of treatment, payment and health care operations unless an exception applies (45 C.F.R. § 164.506).
- Learn more.
- Complete a NC HealthConnex Participation Agreement. Review the different types of participation agreements available, and select the agreement most suitable for your organization. Carefully read and complete the agreement. It may be returned either by email to email@example.com (preferred method) or by mail to N.C. Health Information Exchange Authority Mail Service Center 4101 Raleigh, NC 27699-4101.
- Review the technology specifications and data targets to ensure that you or your electronic health records vendor has the required technology in place
- Contact us. For any questions or concerns about participation with NC HealthConnex, please contact us at firstname.lastname@example.org or 919-754-6912.
The NC HIEA has observed a variety of timelines to complete the connection process depending on a variety of factors, including whether an organization is brining on a new electronic health records system before onboarding to NC HealthConnex.