The Latest NC Medicaid Managed Care News
The Latest NC Medicaid Managed Care News


NC Health Information Exchange Authority
NC HealthConnex
February Update

Preparing to Support Medicaid Managed Care

This year is sure to bring great change to the business models for North Carolina’s health care providers as the state plans to launch Medicaid Managed Care in the latter half of the year. For many providers, this will mean reevaluating their approaches to population health and care management of their residents.

As practices look to become NC Medicaid Advanced Medical Homes (AMHs) and qualify for enhanced Medicaid reimbursements, they will need to determine how to most efficiently access and leverage data on their patients’ care administered outside of their practice, within their daily workflows. The North Carolina Department of Health and Human Services (NC DHHS) has released a data strategy policy paper on this topic wherein NC HealthConnex is noted as a data partner who can meet this need for its participating providers, and at no cost

The NC HIEA has partnered with NC DHHS throughout the planning process to ensure its HIE services can provide timely access to the individual-level patient data across care sites that AMHs will need, while minimizing the administrative and cost implications of the new data and quality requirements. NC HealthConnex already provides access to this data from more than 4,500 facilities statewide (with more than 3,500 more in the onboarding process) via the NC HealthConnex Clinical Portal or directly within a participating provider’s EHR.

What’s more, NC*Notify, the event notification service powered by NC HealthConnex, provides a pushed-daily report of the information that Tier 3 and Tier 4 AMHs will need to maintain their status and highest-level reimbursements on their specified patient panel. This information includes hospital Admission, Discharge, and Transfer (ADT) data.

In addition to working directly with our participants, the NC HIEA stands ready to partner with NC Medicaid’s Prepaid Health Plans (PHPs) as soon as they are announced to efficiently assist our participants in their data needs under Medicaid Managed Care. We look forward to helping providers leverage statewide HIE to improve patient care and reduce cost to the system at large while meeting their new requirements under the managed care model.

For more information, including NC*Notify Enrollment, please go here.


North Carolina Assisted Living Association


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