Credentialing Corner

Ten priorities for your attention: 

1. DMEPOS suppliers: CMS has withdrawn BOC accreditation authority effective December 2, 2025. Suppliers with expiring accreditation must transition to one of seven CMS-approved organizations immediately to maintain Medicare billing privileges. 

2. New York hospital networks: Mount Sinai Health System and NewYork-Presbyterian are terminating contracts with multiple major payers effective January 1, 2026. Verify hospital network status before making referrals and communicate changes to patients requiring hospital services. 

3. Anthem access standards: New compliance monitoring has been implemented for appointment availability timeframes. Providers must offer preventive care within 30-60 days (state-specific), urgent care within 24 hours, and maintain compliant 24/7 after-hours coverage. 

4. Centers Plan acquisition: Anthem HP is acquiring Centers Plan for Healthy Living, with MAP members transitioning January 1, 2026, and MLTC members transitioning March 1, 2026. Current Centers Plan network participation does not automatically transfer to Anthem HP. 

5. Availity system update: Cigna Medicare Advantage will be renamed HealthSpring Medicare Advantage in Availity Essentials effective January 1, 2026. Update payer selections accordingly. 

6. New York providers: Applications are now open for the $48.3M HEALR loan repayment program, with employer-sponsored applications due January 31, 2026, and individual applications due February 15, 2026. Maximum awards range from $50,000 to $300,000 depending on specialty. 

7. Medicare telehealth: Current flexibilities have been extended through January 30, 2026, but providers should prepare for potential policy changes as federal legislation remains under consideration. 

8. Prior authorization: New CMS response time requirements take effect January 1, 2026, requiring standard requests to be completed within 7 days and expedited requests within 72 hours. Incomplete documentation will likely result in outright denials rather than requests for additional information. 

9. Cultural competency requirements: Free, accredited training offering CME and CE credits is available through Horizon BCBS of New Jersey through year-end 2025. 

10. Plan changes: Multiple payer updates take effect January 1, 2026, including Fidelis Care Medicare Advantage plan name changes, new product offerings, and formulary modifications. MVP Health Care and Independent Health have announced a pending affiliation that will create a nearly one-million-member organization across New York and Vermont.