Provider Outreach to Members

Some providers are encouraging patients to sign up for managed care (i.e. the Standard Plans) and listing the health plans they have contracted with to help patients with health plan selection. We welcome this engagement from our providers, but please note that not all Medicaid members are moving to managed care now. We understand receiving letters or other information from providers to sign up for a health plan is causing some confusion for our members who are not required to sign up at this time.

Members who are not required to sign up include those on the Innovations Waiver or people receiving intensive mental health or substance abuse services.

If you hear from your provider conducting outreach, we encourage you to call the NC Medicaid Enrollment Broker at 833-870-5500 (TTY: 833-870-5588). The enrollment broker can tell you if you are required to sign up for Medicaid Managed Care at this time and can help you with making an informed choice if you are.

Electronic Health Records - Health Information Exchange

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EHR & HIE

The North Carolina General Assembly created the North Carolina Health Information Exchange Authority (NC HIEA) to oversee and administer the state-designated health information exchange (HIE) (NCGS 90-414.7).

NC HealthConnex is North Carolina’s new, modernized HIE that delivers added value to the conversations that are happening at all levels in the health care industry. It breaks down information silos between providers, achieves greater outcomes for patients, and creates efficiencies in state-funded programs such as Medicaid.

The original plan was to have all providers who receive state funds (e.g., Medicaid, NC Health Choice, State Health Plan, etc.) for the provision of health care services to connect to NC HealthConnex by specific dates in 2018 and 2019 to continue to receive payments for services provided (NCSL 2015-241 as amended by NCSL 2017-57). Specifically:

  • Hospitals, physicians, physician assistants, and nurse practitioners who provide Medicaid services and who have an electronic health record system must connect by June 1, 2018.
  • All other providers of Medicaid and state-funded services must connect by June 1, 2019.
  • Local Management Entities/Managed Care Organizations (LMEs/MCOs) are required to submit encounter and claims data by June 1, 2020.

Governor Roy Cooper signed House Bill 395 (now NCSL 2021-26) into law on May 27, 2021, to allow additional time for providers to connect to the state-designated health information exchange NC HealthConnex, among other things. NCSL 2021-26 provides for the allowance to “Extend the connection deadline for most providers of Medicaid and State-funded health care services, and affiliated entities, until January 1, 2023 (currently October 1, 2021).”

Providers are advised to review the latest HealthConnex updates here.

How to Connect:

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If you find any wrong or out of date information on our pages, we want to know. Please email Info@TrilliumNC.org with any corrections.