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.