Each year, Point32Health assesses provider network tiers for Harvard Pilgrim’s ChoiceNet HMO and PPO plans and notifies physician groups and hospitals whose tiers changed of their new tier assignments for these products.
For 2024, we will not be refreshing tier assignments for the ChoiceNet products; all provider tier classifications will remain consistent with classifications for the 2023 plan year.
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. Point32Health determines 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, Point32Health utilizes 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 are unavailable, tiers are based solely on health status adjusted total medical expenses or relative prices, or both.
Harvard Pilgrim’s Provider Directory currently reflects 2023 tier assignments, and these will remain unchanged for 2024. For more information, please see the Tiered Network Plans section of the Learn About Our Products page on Harvard Pilgrim’s provider website.
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