New tier assignments for Harvard Pilgrim’s ChoiceNet HMO and PPO plans take effect on Jan. 1, 2022, and last month Harvard Pilgrim mailed letters notifying physician groups and hospitals whose tier changed of their new tier assignments for these products.
ChoiceNet HMO and PPO are tiered network plans for which 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. To develop the quality score used to determine tier placement, Harvard Pilgrim utilized measures endorsed in the Standard Quality Measurement Set (SQMS), introduced by the Massachusetts Statewide Quality Advisory Committee to provide a standardized quality measurement system. If applicable quality measures were unavailable, tiers were based solely on health status adjusted total medical expenses or relative prices, or both.
The Provider Directory will be updated to reflect the 2022 tier assignments.
For more information, please see the Tiered Network Plans section of the Learn About Our Products page on Harvard Pilgrim’s provider website. If you have any further questions on your tiering, please contact your contract manager.