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Tiered Network Plans: ChoiceNet and Hospital Prefer

ChoiceNet
Harvard Pilgrim offers ChoiceNet HMO and ChoiceNet PPO, tiered network versions of the Best Buy HMO and PPO products. ChoiceNet is available to employer groups in Massachusetts and New Hampshire.

Hospital Prefer
As a compliment to Harvard Pilgrim’s ChoiceNet HMO and PPO products, the Hospital Prefer product offers a simplified network design that tiers hospitals only. Hospital Prefer is available to employer groups in Massachusetts and New Hampshire.

Provider Tiering
Member cost sharing falls into one of three tiers, as determined by the provider’s tier assignment. Harvard Pilgrim determined network tier assignments for physician groups and hospitals based on quality and cost performance as measured by health status adjusted total medical expenses and relative prices. The hospital tiering methodology and resulting tier assignments are one and the same for the ChoiceNet and Hospital Prefer products. Physician tiering applies only to ChoiceNet.

Provider tier assignments are available in the Provider Directory and providers are notified annually of any changes in tier assignments for the upcoming calendar year.
 
For complete product information, as well as details about Harvard Pilgrim’s tiering methodology and provider tier appeal process, please refer to the documents below.


Product administration information

Fast Facts (tiering methodology)


2018 plan year (effective January 1, 2018)


2017 plan year (effective January 1, 2017)


Provider tier appeals

 
Key Contacts
Provider Service Center
(800) 708-4414
Referral & Authorization Requests
(800) 708-4414
Behavioral Health Care Resources
(888) 777-4742
Care Management
(888) 888-4742,
Ext. 31035
EDI Team
(800) 708-4414 (Option 1; then press 3)
HPHConnect
(800) 708-4414
(Option 1; then
press 6)
Provider Relations Consultants (PRC)
  • CT
    (877) 594-7190
  • MA/RI
    (888) 888-4742
  • ME
    (888) 476-2463
  • NH
    (800) 544-9759

Who's my Provider Relations Consultant?
Key Contacts Directory (Download)