Physicians/Specialists
Facilities/Hospitals
Ancillary
Publication Date: 
2019-03-05

The North Carolina General Assembly enacted General Statute G.S. 90-414. This requires North Carolina health care providers who receive state funds for health care services (Medicaid and State Health plan members) to connect to the state-designated health information exchange, NC HealthConnex, and provide electronic health records before receiving reimbursement.

Your compliance is based on whether or not you have entered into an agreement to begin submitting data from your electronic health record information to the North Carolina Health Information Exchange Authority (NC HIEA) compliance office. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) does not control the determination of compliance between providers and the NC HIEA compliance office.

The effective date of this mandated change is based on provider type, as follows. However, per the NC HIEA, providers in the process of onboarding have been granted an extension and will not be considered non-compliant. 

  • June 1, 2018 - Certain defined hospitals, physicians, physician assistants, and nurse practitioners with existing EHR record systems
    • The legislature granted a one-year extension from the originally-published effective date. This makes compliance required by June 1, 2019.
  • June 1, 2019 – All other providers not included in the defined group above
    • The legislature granted a one-year extension from the originally-published effective date. This makes compliance required by June 1, 2020.
  • June 1, 2020 – Local Management Entities and Managed Care Organizations

Beginning June 1, 2019, Blue Cross NC will reject all State Health Plan claims received from a NC HIEA non-compliant provider, until the provider becomes compliant. This will be based on the NPI compliance information we receive from the NC HIEA.

We want to make sure you’re prepared and can avoid potential delays in your Blue Cross NC claim payments for services rendered to State Health Plan members. We encourage you to reach out to your technical support teams to be sure you’re already, or plan to be ready, on or before the compliance effective date for your provider type.

For more information about the NC HIEA and requirements to submit patient and clinical data via electronic health records, please visit NC Health Connex, or contact the Health Information Exchange Authority, at hiea@nc.gov.