07/21/2023
PPI reports are planned to be available on August 21, 2023, for physicians having information at or above credibility thresholds in a category for the Physician Efficiency, Appropriateness, and QualitySM (PEAQSM) program. These reports show how physicians compare to peers and include information to improve future performance.
How Does This Impact a Provider?
Provider Finder® searches are influenced by PEAQ scoring. Better performers show up higher in results, though no scoring is currently visible to users. Members who utilize Provider Finder to get care from high performers may be eligible for Member Rewards.
Reconsiderations
In accordance with Texas law, physicians may request more details about their PPI results or ask for a reconsideration of their results. Requests for reconsideration must be submitted to PEAQ_inquiries@bcbstx.com or a provider network consultant within 45 days of report delivery.
The PPI reports can be reviewed at no cost via Availity® beginning August 21, 2023 for qualified providers in the following specialties:
Medical |
Surgical |
Primary Care |
Cardiology Endocrinology Gastroenterology Nephrology Pulmonary Rheumatology Obstetrics/Gynecology |
Cardiothoracic Surgery Ophthalmology Orthopedic Surgery Urology Vascular Surgery |
Family Medicine Internal Medicine Pediatrics |
If you are not registered for Availity, sign up for a free account by going to Availity and selecting “Register” in the top right corner. Refer to the Availity User Guide for information on viewing PPI reports.
PEAQ 101
Following PPI report delivery, the PEAQ team will offer PEAQ 101 sessions for physicians to learn more about the program. In these sessions, the team will provide a brief overview of the program, review PPI reports, and address pre-submitted questions. Register for these sessions below, select your preferred date (Central Time Zone). Also, submit your questions in advance to PEAQ_analytics@bcbstx.com.
PPI reports employ logic from the August 2020 Methodology (V1.1) for the medical appropriateness component and from the May 2022 Methodology (V2.0) for quality of care and cost-efficiency components.
BCBSTX is committed to continuous improvement and reevaluation of our methodology regularly based on feedback and recent clinical evidence. For more information about PEAQ, visit the BCBSTX PEAQ site or email PEAQ_analytics@bcbstx.com.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.