Practices must notify us within 30 days of any changes to their participant NPIs or service locations. Additions or removals should be flagged to Pearl by notifying us at help@pearlhealth.com so that we can submit the change to CMS in a timely manner. New providers will participate according to the ad hoc guidance as defined by CMS. For terminated providers, their attributed patients are still aligned to the practice and Pearl for the duration of the Performance Year.
Add/remove NPI: include TIN, NPI, first and last name, and specialty, and full address (if new provider)
Add/remove location: full address including county
Our ACO Operations team will submit any additions/departures on the 1st of every month so please notify us prior.
Additional NPIs that are added mid-way through the performance year via voluntary alignment would contribute towards the benchmark (and thus shared savings). It would also impact the cap rate and thus indirectly affecting capitation PBPM for the group. However, those providers would not receive capitated revenue for PY24. Cap rate that gets adjusted mid-year then quarterly would reflect any changes from provider add/drop activity.