Can patients fall off my claims alignment?

Exclusion criteria for claims alignment

Ben Troen avatar
Written by Ben Troen
Updated over a week ago

Yes, based on the Exclusion criteria. You can find that from the Participation Agreement.

Each month, Pearl receives an updated Beneficiary Alignment Report (affectionately known as the “BAR”) from CMS that includes a list of REACH ACO patients and patients who have been de-aligned from the ACO. Dealignment can occur for patients who are now deceased, have relocated to a different service area, or switched to a Medicare Advantage plan.

There may be a lag in which patients fall off of claims alignment. For deceased patients, it will take about a month to reflect in the Pearl Platform because we won't have access to the data. Once we have the data, these patients will fall off of the following month's report. The article here also provides additional explanation around alignment list updates.

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