NC HealthConnex Bidirectional Interface Confirmation Form

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The N.C. Health Information Exchange Authority can help determine whether your practice participates in a bidirectional exchange with a health information exchange to support care transitions. The Centers for Medicare & Medicaid requires that clinicians and groups do so to be eligible for the Merit-Based Incentive Payment System.

Submit the form below to receive confirmation of your bidirectional connection to NC HealthConnex.

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Organization Information

Organization Contact
Provide your organization's 10-digit national provider number.

Participant Account Administrator Information

HIEA will direct further communication to this email address.

Electronic Health Records Vendor Information

This question is for testing whether or not you are a human