Health Care Provider FAQs

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 July 22, 2024

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NC HealthConnex exists to improve health care quality, enhance patient safety, improve health outcomes and reduce overall health care costs by enabling health information to be readily available to health care providers and clinical staff across the state. It empowers providers with nearly real-time clinical information that links to colleagues across North Carolina and travels securely to their practices, ultimately helping reduce medical errors and duplicate procedures.

The full list of value-added features is as follows:

  • Exchange services (EHR integration, clinical portal, eHealth Exchange)
  • Secure messaging services
  • Registry services
  • Notification services
  • Data quality
  • Work groups

Participants will receive patient information from other provider organizations with whom they share a relationship. This information will include laboratory results, diagnostic studies and clinical documents. Current data elements available in NC HealthConnex include:

  • Demographics
  • Encounters
  • Allergies
  • Immunizations
  • Medications
  • Problems
  • Procedures
  • Results

These electronic health records vendors are live and submitting data to NC HealthConnex. This list is not exhaustive. NC HealthConnex is continuing to grow and work with new vendors. To ensure that vendors can meet NC HealthConnex standards, review the technology specifications, and discuss them with your vendor.

The N.C. Health Information Exchange Authority offers a variety of connection options to NC HealthConnex. However, there are some instances in which an electronic health record vendor does not have the technical capability to connect to NC HealthConnex. In those instances, you will receive correspondence from NC HIEA about this and options for possible next steps.

The participant account administrator for your organization is responsible for managing the creation of user accounts. Please contact your participant account administratorto request access to the NC HealthConnex portal or a direct secure messaging account. If you do not know your participant account administrator, please contact the N.C. Health Information Exchange Authority Help Desk team at or (919) 531-2700.

The N.C. Health Information Exchange Authority takes its role as steward of patient data very seriously and gives credentials to the participant’s assigned participant account administrator, who grants health care providers access based on their specific role within the health care organization. NC HealthConnex is configured with various clinical views that end users can access. Not all views need to be accessed by all users, and access can be based on sensitivity of information or relevance to the user. User groups and roles are used to control this access.

Organizations that have a full participation agreement may access NC HealthConnex data via either a unidirectional or a bidirectional (electronic health records-integrated) data connection. Organizations with a unidirectional connection or integration to NC HealthConnex may access longitudinal patient records via the NC HealthConnex clinical portal. Organizations connected bidirectionally may access NC HealthConnex data via their organizational electronic health record.

Note: Bidirectional data connections to NC HealthConnex are dependent upon your electronic health record’s technical capability. Please work with your electronic health records vendor to determine if this is an option for your organization.

Alcohol and substance use disorder programs that hold themselves out as or advertise as providers of substance use disorder treatment and who receive any type of federal assistance as outlined in 42 C.F.R. Part 2 cannot generally disclose data through to NC HealthConnex in the following conditions:

  1. If the data would identify a patient as an alcohol or substance abuser, and
  2. If that data was obtained by an alcohol or substance abuse program for treating, diagnosing or making a referral for the patient’s alcohol or substance abuse problem.

Units within a larger health care organization that are covered by 42 C.F.R. Part 2 should also withhold patient data pertaining to substance use disorder patients. However, the remaining clinical data (e.g., general medical information, mental health data, procedures and laboratory tests) can be submitted to NC HealthConnex.

Part 2 providers may disclose part 2 information in the event of an emergency directly to a requesting physician if he or she needs the information to treat the emergency condition pursuant to 42 C.F.R. §2.51 or if the patient has authorized the specific disclosure in writing in compliance with 42 C.F.R. § 2.31. This can be done using NC HealthConnex direct secure messaging. Please review 42 C.F.R. Part 2 before disclosing any alcohol or substance abuse information through NC HealthConnex.

Yes. Most behavioral health information is permitted to be shared through NC HealthConnex. However, the Health Insurance Portability and Accountability Act does not allow mental health providers to disclose a patient’s psychotherapy notes to others unless the patient authorizes the disclosure.

Although participants cannot submit Part 2 data or psychotherapy notes to the NC HealthConnex data repository, participants are permitted to share these types of information via direct secure messaging with other participants through NC HealthConnex. The provider sending the message must comply with applicable law and obtain the required consent or authorization from the patient before disclosing the data. Learn more about the N.C. Health Information Exchange Authority’s secure messaging service.

The HIPAA Privacy Rule defines “psychotherapy notes” as follows:

Notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint or family counseling session and that are separated from the rest of the individual’s medical record. Psychotherapy notes exclude medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests and any summary of the following items: diagnosis, functional status, the treatment plan, symptoms, prognosis and progress to date.

The Health Information Exchange Act explicitly provides individual patients the right to opt out of NC HealthConnex. The legislation defines “opt out” as “an individual's affirmative decision communicated to the Authority in writing to disallow his or her protected health information from being disclosed by the Authority to covered entities or other persons or entities through the HIE Network” (NCGS § 90-414.3(13)).

The opt-out model for North Carolina was adopted in 2012. The decision to choose this consent model was included in an operational plan that was submitted to the Office of the National Coordinator for Health Information Technology within the U.S. Department of Health and Human Services. In an opt-out state, all data related to North Carolina patients submitted to NC HealthConnex, regardless of payer, is viewable by certain authorized users who can access clinical records unless a patient opts out of exchange. The HIE Act also permits the N.C. Health Information Exchange Authority to retain a copy of an opted-out individual’s patient records in the NC HealthConnex system but prohibits disclosure or access unless an exception applies (NCGS § 90-414.11(4)).

NC HIEA ensures that providers educate patients about their opt-out rights through obligations assigned to participants in the NC HealthConnex Participation Agreements, distribution of provider and patient education brochures to participants and provision of a sample provision for providers’ patient-facing notices of privacy practices that explains data will be submitted to NC HealthConnex. NC HIEA also provides information on its website to directly communicate to patients the benefits of the health information exchange and how it works to improve care coordination and quality of care, as well as their choice to opt out.

The Health Information Exchange Act requires that the N.C. Health Information Exchange Authority ensure that health care providers educate their patients about NC HealthConnex and the right to opt out or rescind a decision to opt out (NCGS 90-414.7(b)(1)(d)). To aid participants and providers in educating their staff and patients about NC HealthConnex, a comprehensive welcome packet is sent at the time of contract execution via email. It is also available on the website. The packet contains:

Initial Announcement Tools

  • Sample initial email for the chief information officer and chief executive officer
  • Sample employee newsletter announcement
  • Talking points to educate employees
  • NC HIEA fact sheet

Go Live Announcement Tools

  • Sample press release
  • Sample senior leader email
  • Talking points to educate patients
  • Frequently asked questions for patients

Patient Education

  • 8.5 x 11 fact sheet (available via the NC HIEA website for you to print or provide electronically)
  • Waiting room tri-fold brochure order form (printed and mailed to participants at no charge)
  • Opt-out form (this will be available via the NC HIEA website for patients/providers to access)
  • Sample notice of privacy practices excerpt about disclosures to NC HealthConnex

How patients are educated on their right to opt out is subject to the discretion of the health care provider. NC HIEA provides tools and resources in the welcome packet and reference information for providers to utilize to educate their patients to, but they are not required for use. We do, however, encourage providers to include a statement about disclosures made to NC HealthConnex in their notice of privacy practices, so providers can ensure all of their patients have been given the opportunity to read about the disclosure to NC HealthConnex.

After signing a participation agreement, the technical onboarding process will begin. It can take more than 12 weeks for a connection to be built and for data to start flowing to NC HealthConnex. Providers are encouraged to use this time to educate patients about their organization’s participation in NC HealthConnex and the benefits of health information exchange to improve care and lower costs.

Opt-out forms are readily available online on our For Patients page. Once the patient mails the form to the N.C. Health Information Exchange Authority, and it is received by our office, it can be processed within two business days. Forms must be completed in their entirety to be processed. Partially completed forms are not accepted.

Once a health care provider signs a participation agreement, NC HIEA provides a welcome packet, which includes valuable patient education and opt-out materials. Providers can choose how they include this information in their workflow. However, we encourage providers to include a statement about disclosures made to NC HealthConnex in their notice of privacy practices. We recommend that participants begin patient education as soon as they sign the participation agreement, while their facility is in onboarding for the technical connection. NC HIEA also offers information for patients.

Currently, there is no fee to connect. The N.C. Health Information Exchange Authority is funded by the state of North Carolina, with a goal to be receipts-supported in the future. The N.C. General Assembly believes in the value of a robust state-operated health information exchange and has committed $9 million annually to this endeavor. As we develop a roadmap for future sustainability, fees related to the consumption of value-added features will be vetted thoroughly with all stakeholders and recommended to the General Assembly before any final decisions are made.

Note: While there are currently no fees charged by the state for the connection to or use of NC HealthConnex, some electronic health records vendors may charge fees (e.g., technical build, maintenance) to their customers for this connection.

There are no fees to obtain a direct secure messaging account. Direct secure messaging is a safe, scalable and standards-based method for the exchange of protected health information. However, medical providers will need to sign a full participation agreement to receive credentials.

Note: Direct secure messaging credentials are part of the package of N.C. Health Information Exchange Authority services that includes a technical connection to submit data. For more information, access the direct secure messaging fact sheet.

The 2022 Appropriations Act temporarily suspended the enforcement mechanism in the Statewide Health Information Exchange Act that makes connection to the HIE and submission of required data to the state prerequisites for a health care provider to receive state funds. At this point, y provision that would prevent “unconnected” providers and entities who are not connected to NC HealthConnex may receive state funds for treating Medicaid recipients and State Health Plan members. Providers – even those not yet connected to NC HealthConnex – may continue to see state-funded patients without fear that the state will enforce the “condition of receiving state funds” provision of the Statewide Health Information Exchange Act at this time.

However, the legal mandate to connect by Jan. 1, 2023, for certain providers remains, and this suspension of enforcement is only temporary the N.C. General Assembly enacts into law “a bill designating a lead agency responsible for enforcement of the Statewide Health Information Exchange Act.”  In March 2023, the General Assembly will receive a report outlining the status of organizations that met – or failed to meet – the January 1, 2023, connection and submission deadline. 

At this time, the N.C. Health Information Exchange Authority’s (NC HIEA) Advisory Board may also offer additional recommendations to the General Assembly about enforcement of the Statewide Health Information Exchange Act and about enhancements to NC HealthConnex. These recommendations will supplement a report and recommendations that the NC HIEA Advisory Board submitted to the General Assembly this spring, which focused on data connections, supporting patients, and protecting the networks of providers who serve state-funded patients.

The statutory provision that would prevent "unconnected" providers and entities from receiving state funds for treating Medicaid recipients and State Health Plan members is currently suspended as a matter of law. Providers – even those not yet connected to NC HealthConnex – may continue to see state-funded patients without fear that the state will enforce the "condition of receiving state funds" provision of the Statewide Health Information Exchange Act at this time.  

Yes. To connect and submit data to NC HealthConnex, you must have an electronic health records system that is minimally capable of sending HL7 messages, version 2 or higher. The N.C. Health Information Exchange Authority is working with more than 200 electronic health records vendors, including those vendors submitting data. We encourage you to procure an electronic health records system as soon as you are able to begin the connection process. Connecting to NC HealthConnex can take up 12 months, depending on your electronic health records software.

No. However, the N.C. General Assembly directed the N.C. Health Information Exchange Authority, in partnership with the N.C. Department of Health and Human Services and the State Health Plan, to conduct a feasibility study to understand the types of providers impacted by the HIE Act, the data collected and how it an be used in NC HIEA for patient care and alternative methods of connection and data transport. See the study results. House Bill 70 was introduced during the 2019 legislative session to allow certain providers to be exempted from the requirement to submit data to NC HIEA. These providers may still voluntarily connect to the NC HIEA network and submit data.

Coastal Connect Health Information Exchange (CCHIE) ceased operations on August 8, 2023. The NC HIEA is working to help participants transition to NC HealthConnex, the state designated HIE.

The first step for CCHIE participants to transition to NC HealthConnex is to fill out a Participation Agreement.

We have co-hosted two webinars to help answer questions regarding the transition of CCHIE’s participants to NC HealthConnex as well as an overview of NC HealthConnex value added services. Please see the links below for more information or contact

CCHIE Transition & NC HealthConnex Webinar

NC HealthConnex and Coastal Connect HIE: ADT Alerts and NC*Notify Webinar

What does the new law say regarding chiropractors' exemption to the mandate to connect to NC HealthConnex?

The HIE Act (N.C.G.S. § 90-414.4) requires that those providers who receive state funds, such as Medicaid and the State Health Plan, for the provision of health care services must initiate a connection to send data to NC HealthConnex. Previously, certain provider types were exempted from the mandatory requirement to connect and send data by N.C.S.L. § 2019-23. 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.

The following is an expanded list of provider types that have the option to connect on a voluntary basis:

  1. Community-based long-term services and supports providers, including personal care services, private duty nursing, home health, and hospice care providers.
  2. Intellectual and developmental disability services and supports providers, such as day supports and supported living providers.
  3. Community Alternatives Program waiver services (including CAP/DA, CAP/C, and Innovations) providers.
  4. Eye and vision services providers.
  5. Speech, language, and hearing services providers.
  6. Occupational and physical therapy providers.
  7. Durable medical equipment providers.
  8. Nonemergency medical transportation service providers.
  9. Ambulance (emergency medical transportation service) providers.
  10. Local education agencies and school-based health providers.
  11. Chiropractors licensed under Article 8 of this Chapter.


If I am no longer required to connect, may I still choose to participate with NC HealthConnex?

Yes! Providers covered by N.C.G.S. § 90-414.4(e) may voluntarily choose to submit data to NC HealthConnex or they can access patient data in the clinical portal and utilize the NC HealthConnex value-added features. Voluntary providers must sign a Full Participation Agreement if they want to participate. Submission Only Agreements do not include a Business Associate Agreement and therefore can only be signed by providers who are required to connect and submit data to NC HealthConnex.


What do I do if I am no longer required to connect but have already submitted a Full Participation Agreement?

  • You have the option to continue your relationship as an NC HealthConnex participant. You may choose to still submit data to NC HealthConnex, or you may simply receive access to the clinical portal and other value‐added services. Having access to the clinical portal will allow you to view a more complete health record for patients with whom you have treatment relationship. No action is necessary at this time if you plan to remain a full participant of NC HealthConnex. As a reminder, anyone with a Full Participation Agreement has access to our Suite of Services, regardless of your organization's connection status.
  • If you do not want to submit data to NC HealthConnex or access patient data, you may terminate your agreement. If your agreement has not been signed by the NC HIEA yet, you can request that the agreement not be finalized. Please send an email to if you do not want the NC HIEA to process your participation agreement or you would like to terminate it. This will end your relationship with the NC HIEA and NC HealthConnex.


What do I do if I am no longer required to connect but submitted a Submission Only Agreement?

  • The NC HIEA will reach out to you about terminating or replacing your agreement soon.
  • If your organization would like to voluntarily participate in NC HealthConnex in order to view patient records or utilize the NC HealthConnex value‐added features, your organization can complete a Full Participation Agreement.


What do I do if am no longer required to connect but have already gone live in production (already connected to NC HealthConnex)?

If you wish to terminate your connection, reach out the NC HIEA to begin the termination process. You can contact us at or at 919-754-6912. If you wish to continue your connection, please see the instructions above for what to do if you have a Submission Only or a Full Participation Agreement.


What if my organization has signed a participation agreement with the NC HIEA, but we are now no longer required to connect per changes in N.C.S.L. 2023-137?

Provider types listed under N.C.G.S. § 90‐414.4(e) who are no longer required to connect have several choices. Voluntary providers can still connect to NC HealthConnex, but they must sign a Full Participation Agreement. Submission Only agreements will not be processed for providers not required to connect.

Section 11 of the North Carolina Health Information Exchange Authority’s Privacy & Security Policies for NC HealthConnex provides that the N.C. Health Information Exchange Authority (NC HIEA) shall approve the general types of public health purposes for which it may disclose protected health information. The NC HIEA has approved the following public health purpose for which protected health information may be disclosed:

Read-only access to the records of individuals who have or may have a reportable communicable disease for case identification and contact tracing pursuant to G.S. 130A-144(b).

N.C.G.S. 130A-144(b) provides that “[p]hysicians, persons in charge of medical facilities or laboratories, and other persons shall, upon request and proper identification, permit a local health director or the State Health Director to examine, review, and obtain a copy of medical or other records in their possession or under their control which the State Health Director or a local health director determines pertain to the (i) diagnosis, treatment, or prevention of a communicable disease or communicable condition for a person infected, exposed, or reasonably suspected of being infected or exposed to such a disease or condition, or (ii) the investigation of a known or reasonably suspected outbreak of a communicable disease or communicable condition.”

The use of NC HealthConnex for public health purposes must comply with all the terms of the NC HIEA’s Participation Agreement. For more information, please review the language in the Participation Agreement or email us at