Back to Insights and Updates for ProvidersNovember 2023

Identifying alternate providers when terminating from the network

Harvard Pilgrim Stride (HMO) Medicare Advantage  |  Tufts Health Plan Senior Care Options  |  Tufts Health Unify  |  Tufts Medicare Preferred

When a provider terminates from a Medicare Advantage Organization’s network, the Centers for Medicare & Medicaid Services (CMS) now requires that the organization share a list of alternate in-network providers with members who were receiving treatment from the terminating provider to ensure continued care.

As a reminder, provider terminations must be submitted to Point32Health with advance notice per contractual terms and policies. Upon submitting a provider termination notice to Point32Health, please identify two alternate providers within the practice who are available to members. Include the following information in the provider termination request:

  • Alternate provider names
  • Alternate provider NPIs
  • Alternate provider phone numbers

If no alternate providers are available within the practice, please work with your physician organization to identify the alternates. Point32Health will select alternate providers to share with the member if none are identified in the termination request.

Audrey Kleinberg,
Director, Provider Relations & Communications

Annmarie Dadoly,
Senior Manager, Provider Communications

Joseph O’Riordan, Susan Panos, Stephen Wong,

Kristin Edmonston,
Production Coordinator

Kristina Cicelova,
Graphic Designer