Patients can have visits with their assigned provider as well as any other provider in the practice as long as they are under the same Tax Identification Number (TIN). Patients are aligned to an NPI as well as a TIN, so Pearl Health reimburses practices based on the TIN level. They can also use any doctor, other health care professional, or hospital that accepts Medicare, at any time. Best practice is to invite even those patients that are already claims aligned to sign the voluntary alignment (VA) form. Keep in mind these patients will likely be mailed a VA form, and you can also present the form in office. This is especially important in areas where other REACH ACOs are present to ensure your patients remain assigned to you year over year. If one of your claims-aligned patients has a visit with a provider active in another REACH ACO and signs a VA form elsewhere, Medicare will prioritize the other ACO’s voluntary alignment over your claims-alignment starting in the following year.