Last month, Harvard Pilgrim notified physician groups and hospitals in Massachusetts and New Hampshire of changes in their respective tier assignments for Harvard Pilgrim’s ChoiceNet and Hospital Prefer plans. The new tier assignments will take effect on January 1, 2014.
The ChoiceNet HMO and PPO plans are tiered network versions of the Best Buy HMO and PPO plans. Physician tiering applies only to ChoiceNet; the Hospital Prefer plan offers a simplified network design that tiers hospitals only.
For both plans, member cost sharing falls into one of three tiers, as determined by the provider’s tier assignment. Harvard Pilgrim determined network tier assignments based on quality and cost performance, as measured by health status adjusted total medical expenses and relative prices. The Provider Directory will be updated by October 1, 2013 to reflect the 2014 tier assignments.
For more information, including links to product administration information, a description of the tiering methodology, and provider tier appeal guidelines, please see the Tiered Network Plans page.