BlueChoice POS participating physicians are reimbursed fee for service based on a five tier reimbursement system, up to a maximum charge allowance. The tiering methodology is designed to recognize and reward provider performance as it relates to specific performance parameters which may include administrative compliance, open/closed practice status, member complaints, corrective action and cost/utilization management.

Performance in relation to the Clinical Quality Indicators may raise the reimbursement tier assignment. Assignments occur annually or more often in special circumstances. Most Providers are reimbursed at the standard tier three level, reflecting performance consistent with BlueChoice Network norms. Tiers one and two reflect performance that is below BlueChoice Network norms. Tiers four and five reflect performance that is above BlueChoice Network norms.

Health Benchmarks Clinical Quality Indicator Abstracts