Key Takeaways
Carelon / CAQH — Address Removal = Termination. If you or anyone on your team removes all Service Line addresses from your CAQH ProView profile, Carelon will treat it as a termination. Keep at least one active address on file at all times, and contact Carelon before making any structural changes. This applies even if you are simply relocating or cleaning up your profile.
Carelon / Availity — New Enrollment Fields for Groups. Group practices adding new providers in Availity will now encounter expanded required fields covering office hours, patient population demographics, and language services. Prepare this information before you submit, and monitor new provider statuses to avoid delays in credentialing.
Carelon — 90-Day Attestation Is Not Optional. Federal law requires providers to attest to their directory data every 90 days. Carelon is also conducting compliance audits, and participation is expected. Review your directory listing regularly, keep all access and availability details current, and use CAQH or ProviderConnect to submit timely attestations.
MetroPlusHealth Gold Plan — Referrals Waived, Prior Auth Unchanged. As of June 1, 2026, Gold Plan members no longer need a PCP referral to see an in-network specialist. Brief your front desk and billing staff. Prior authorization requirements are fully intact — do not conflate the two.
Fidelis Care / Northwell — Watch the July 15 Deadline. If no contract agreement is reached by July 15, 2026, Northwell Health providers will leave the Fidelis Care network. Check fideliscare.org/northwell-providers now to assess your exposure, familiarize yourself with in-network alternatives, and prepare for patient questions about continuity of care through the August 13 transition window.
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