Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is introducing a designation that recognizes high-performing providers who consistently meet established performance criteria.
Eligible providers will receive a “Top Performing Provider” designation in Find Care to help members identify providers who meet Blue Cross NC’s performance criteria when searching for care.
How the designation is determined
Blue Cross NC uses available claims, administrative and specialty data to evaluate provider performance. Defined performance measures and established methodologies determine how results are calculated, compared, and used in designation decisions.
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Step 1: Collect data from sources
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- Claims
- Member eligibility
- Enrollment
- Specialty information
- Data from our analytics partners Motive Medical Intelligence and Blue Health Intelligence
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Step 2: Measure performance
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- Quality of care
- Appropriateness of care
- Cost of care
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Step 3: Determine designation with methodology
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- Measure selection
- Attribution
- Benchmarking
- Scoring
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Provider Performance Analytics Core Methodology Guide (PDF)
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Top Performing Provider Quality Designation (PDF)
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Provider designation eligibility and review process
A provider may not receive the Quality Designation if the applicable performance evaluation does not meet designation criteria based on the available claims-based methodology, specialty-specific measures, data availability, minimum thresholds, or composite performance results. The evaluation may include factors such as adherence to evidence-based clinical guidelines, quality of care, clinical appropriateness of care, and cost of care, depending on the specialty and available data.
Providers who have questions about how the designation was determined, how the methodology was applied, or why a designation does or does not appear in Find Care may contact us through the Provider Analytics Inquiry process.
Contact
If you have questions, please contact the Provider Performance Analytics Team at provideranalyticsinquiry@bcbsnc.com.
Blue Cross NC Provider Performance Analytics is intended to support provider education, transparency, and continuous improvement. Methodologies are reviewed periodically and may evolve based on updated clinical evidence, data availability, stakeholder feedback, regulatory considerations, and operational improvements.