About Us
NC Medicaid Connect
Welcome to the NC Medicaid Connect site, an initiative by the Department of Health and Human Services (DHHS).
This site empowers NC Medicaid Direct beneficiaries to register for and manage access data to their data by approved third-party applications (such as mobile apps), and other insurers. This site is part of our commitment to enhancing healthcare delivery through improved access to health information and seamless data exchange.
Guided by the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule (CMS-9115-F), our aim is to empower patients and healthcare providers with the tools they need for better health management and care coordination.
Designed to provide patients with easy, secure access to their health information, facilitating better health outcomes and patient empowerment.
By leveraging modern standards and technologies, we ensure that patients can view, manage, and share their health data with trusted third-party applications and healthcare providers.
Key Objectives
Core Aims for Enhancing Patient Care
Empowering Beneficiaries
Access to Health Information: Beneficiaries can access their health data anytime, anywhere through secure applications and devices. This includes clinical data, encounter history, and other vital health information.
Control Over Data: Beneficiaries decide who can access their health information, providing explicit consent to share data with payers and third-party applications.
Improving Interoperability
Data Exchange Standards: Implementing the Fast Healthcare Interoperability Resources (FHIR) standard to ensure secure, standardized data exchange between healthcare systems.
Integration: Facilitating the integration of third-party applications with healthcare systems using SMART on FHIR specifications.
Enhancing Care Coordination
Payer-to-Payer Data Exchange: Enabling the transfer of patient data between payers at the beneficiary's request to ensure continuity of care.
Bulk FHIR API: Supporting efficient data sharing with authorized third parties to improve care coordination and support value-based care initiatives.
Implementation Approach
Secure Integration Framework
Secure Access and Authentication
NCID Registration: Beneficiaries, developers and payers must register for a North Carolina Identity Service (NCID) account to access the NC Medicaid portal and APIs; this ensures a secure and standardized authentication process.
IAL2 Verification: Beneficiaries and Developers must undergo identity proofing using Identity Assurance Level 2 (IAL2) verification to ensure they are the person they are claim to be.
Developer and Payer Integration
Sandbox Environment: Providing a sandbox environment for developers and payers to test their applications and integrations using mock data.
Production Environment: Once testing is complete and compliance is ensured, applications can access real beneficiary data through the production environment.
Compliance and Security
HIPAA Compliance: Ensuring all applications and data exchanges comply with the Health Insurance Portability and Accountability Act (HIPAA) to protect patient privacy and data security.
Robust Security Measures: Implementing strong encryption, secure authentication, and regular security audits to safeguard health information.
Benefits to Stakeholders
Impactful Benefits for Success
For Beneficiaries
Better Health Management: With easy access to comprehensive health data, beneficiaries and their representatives can make informed decisions about their health and treatments.
Empowerment: Beneficiaries have full control over their health information, including who can access it and how it is used.
For Healthcare Providers
Improved Care Coordination:Access to up-to-date patient information helps providers offer more coordinated and effective care.
Efficient Data Exchange: Standardized data exchange reduces administrative burdens and enhances the quality of care.
For Developers and Payers
Innovation Opportunities: Access to NC Medicaid APIs allows developers to create innovative health applications that meet the needs of patients and providers.
Streamlined Processes: Efficient data sharing and interoperability improve operational efficiencies and patient satisfaction.