NC*Notify Online Enrollment

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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?
Has your organization signed a Full Participation Agreement governing its connection to NC HealthConnex?