Harvard Pilgrim provides coverage to Massachusetts employees (state and municipal employees and retirees as well as their beneficiaries and survivors) through two tiered products for the Group Insurance Commission (GIC): the Independence Plan PPO and Primary Choice HMO (a limited network tiered plan). The plan year for these products begins on July 1 each year and any updates to provider tier assignments for these products take effect on that date.
In the past, physicians received their tier assignments, along with quality and efficiency reports, from Harvard Pilgrim each January. Other health plans serving GIC employees sent GIC tier notices to physicians, as well, resulting in each provider receiving numerous letters and reports. However, beginning in January 2014, the GIC will mail a single tier notice letter, and quality and efficiency reports, directly to individual physicians. This letter will contain the provider’s tier assignment for each participating health plan, as well as contact information for each health plan. Tier assignments noted in the January letter will be in effect from July 1, 2014–June 30, 2015.
The Independence Plan PPO and Primary Choice HMO also feature tier assignments for hospitals. Harvard Pilgrim will mail these tier notifications directly to hospitals in early January.
Tier assignments will continue to be based on quality and cost efficiency claims data. If, after reviewing your letter, you would like to receive additional information about how Harvard Pilgrim arrived at your tier designation, or if you believe that your tier designation was not correctly determined, email firstname.lastname@example.org. The deadline for inquiries and appeals is three weeks from the date of the letter, and appeal requests should be accompanied by a completed Tier Review Request Form.
For more information, please visit Harvard Pilgrim’s GIC plan page on our provider website. Information on the 2014–2015 plan year—including Fast Facts for Physicians, Frequently Asked Questions, and information on the Physician Review Process (including a link to the Tier Review Request Form)—will be posted in January.