NC*Notify Online Enrollment Submitted by kogardner on Fri, 04/23/2021 - 13:30 Indicates required field Before You Begin Thank you for your interest in NC*Notify. This web-based enrollment form has been designed to help improve your enrollment experience. Before beginning, however, you'll need to have some key pieces of information available while you are completing the form. If you prefer, you can also download and submit a PDF version of this form as well as the NC*Notify Health Plan Enrollment Form. Have Questions? Learn more about NC*Notify and how it works, or check out a list of frequently asked questions. Required Information Full Participation Agreement Only organizations that have a Full Participation Agreement governing its connection to NC HealthConnex are eligible to enroll. If your organization does not have a Full Participation Agreement and you want to use NC*Notify, contact the N.C. Health Information Exchange Authority at hiea@nc.gov for more information. Organization Information You'll need to know high-level information about your facility or organization, including: Name Address NPI Medicaid region Third-Party Information If you would like to share notifications with a third-party, you'll need to know: Organization name Primary contact's name, phone number and email address Connection Information With NC*Notify, you can specify how you would like to send patient panels and receive notification files. If your practice chooses to send patient panels for NC HealthConnex to monitor, you'll need the following information, depending on the options below: Secure File Transfer Protocol (sFTP) IP address provider CIDR block information Direct Secure Message (DSM) DSM address (if your organization has one) Ready to Start? Is your organization a health plan, a payer or a third party receiving notifications on behalf of a provider? Yes No Error message Health plans, payers and/or third parties have not yet been granted access to online enrollment for NC*Notify. The appropriate enrollment form for health plans and payers can be found here. If you are a third-party organization receiving notifications on the behalf of another facility, please have the facility complete the enrollment form and list all appropriate third parties. Has your organization signed a Full Participation Agreement governing its connection to NC HealthConnex? Yes No Error message Only organizations that have a Full Participation Agreement governing its connection to NC HealthConnex are eligible to enroll. If your organization does not have a Full Participation Agreement and you want to use NC*Notify, contact the N.C. Health Information Exchange Authority at hiea@nc.gov for more information. I have all the information listed above and am ready to begin enrollment.
