BLUE REVIEW^SM

August 2024

Provider Finder^® to Rank Providers To Help PPO Members Find Care

Later this year, Provider Finder will add a tiering feature that shows how providers rank against peers in their working specialties for some PPO products. The tier will display only for members in employer groups with a tiered benefit option. Members can use this information to take advantage of incentives such as lower copays and coinsurance for care from high performers.

Tiering is based on composite results of the Physician Efficiency, Appropriateness, & Quality^SM program. This evidence-based program evaluates primary care physicians and some specialists on components of cost efficiency, medical appropriateness, and quality of patient care.

Tiering applies to providers in the following specialties:

• Tier 1 has lower member out-of-pocket costs. It includes behavioral health providers and physicians who have above average composite scores as compared to their peers.
• Tier 2 has standard member out-of-pocket costs. It includes unscored providers* and physicians who have average composite scores as compared to their peers.
• Tier 3 has higher member out-of-pocket costs. It includes physicians who have below average composite scores as compared to their peers.

*Unscored providers include those practicing in specialties evaluated by PEAQ who did not reach minimum criteria thresholds and those who practice in specialties that PEAQ does not currently evaluate. 

If you have questions, contact PEAQ Inquiries. The full PEAQ methodology is on our PEAQ page.