The N.C. Health Information Exchange Authority is partnering with the Division of Health Benefits to leverage NC HealthConnex, the state-designated health information exchange, to support NC Medicaid’s quality and population health efforts by improving data exchange. This initiative is called HIE Medicaid Services (HMS), which includes support for three additional use cases of NC HealthConnex.
Digital Quality Measures (dQMs)
Develop the capabilities to calculate a selected set of Medicaid’s high-priority quality measures combining both administrative data (claims and encounters) with clinical information from providers' EHRs to allow for more timely results.
Read this flyer for more information about the dQM use case.
Health-Related Social Needs (HRSN) Screening
Develop the capabilities to share Medicaid members’ responses to HRSN screening questions with other providers, Prepaid Health Plans (PHPs) and NC Medicaid to prevent unnecessary rescreening and facilitate referrals.
Read this flyer for more information about the HRSN Screening use case.
Care Management (CM) Data Exchange
Improve the ability to exchange claims/encounter data and care management interaction details between PHPs and local care management entities to facilitate seamless transitions of care and support the provision of care management services.
The NC HIEA is seeking current participants of the NC HIEA who would like to become early adopters of the dQM and HRSN use cases in the HMS Program. Your organization may be eligible for financial incentives for participation to support innovation in dQMs and HRSN screening data exchange. To learn more about the program, including eligibility, key activities and available funding review the HMS Early Adopters Program overview.
The HMS Early Adopters Program, led by NC HIEA and NC Medicaid, provides funding and hands-on support to provider organizations willing to lead the way in advancing these efforts. Early Adopters will play a key role in shaping the future of health data exchange in North Carolina.
Apply Now: Interested organizations should fill out this form to submit their information to the HMS Early Adopters Program. Applications are accepted on a rolling basis, with the first cohort of organizations identified in May.
Have Questions? We are holding two information session about the program on Wednesday, April 9 and Thursday, April 10. Registration is required. You only need to attend one session.
- Wednesday, April 9, 2025 - 12 p.m. to 1 p.m. Register here.
- Thursday, April 10, 2025 - 12 p.m. to 1 p.m. Register here.
Need More Information? Send us an email at hms.hiea@nc.gov.
Participation FAQs
No. At this time, participation in these use cases is not mandatory; however, these efforts will not work without early adopters to lead the way.
There is a payment incentive for participating that is still being determined. The NC HIEA is developing a provider support program to welcome early adopters of the dQM and HRSN use cases that will provide time-limited, direct payments to provider organizations upon completion of agreed upon technical and workflow milestones for each use case. Early adopter incentives are still in preliminary planning stages.
All of the data elements related to dQMs are already being sent by providers mandated to connect to NC HealthConnex by the HIE Act. However, providers who wish to join the dQM use case must also undergo certification in the National Committee for Quality Assurance (NCQA) Data Aggregator Validation program and participate in quality improvement initiatives for three priority quality measures which may necessitate technical upgrades and/or strategic workflow changes.
Joining the HRSN use case requires sending in separate data elements in addition to those required by the connection mandate. Provider organizations participating in the HRSN use case will be asked to map their HRSN screening questions and patients’ responses to the applicable codes defined in the Logical Observation Identifiers Names and Codes (LOINC) standards and transmit that information to NC HealthConnex. Materials are being created that will explain these optional connections.
We are developing materials that will explain each of these use cases in more detail. We will continue to share this information as it becomes available. Please subscribe to the NC HIEA newsletter and check our website to follow updates on this initiative.
If your organization is interested in being an early participant in our efforts to support dQMs or collect standardized HRSN data, reach out to our business development team at hms.hiea@nc.gov.