PayerIQ
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Tier 4CAMedicaid

Centene Medicaid California

Deprioritize — minimal contact + revisit annually

Composite
40.3
Rank
#248
Members
3.5M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
68
+17.0
Lives
20%
17
+3.4
Geography
20%
41
+8.2
Restrictions
15%
24
+3.6
Relationship
10%
35
+3.5
Financials
10%
46
+4.6
Composite Score40.3
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 17.0 + 3.4 + 8.2 + 3.6 + 3.5 + 4.6 = 40.3
Intelligence

Qualitative intelligence

Members
3.5M
Drug spend
$0.7B
Formulary
4-tier
PA / RA level
Moderate
Biosimilar policy
No policy defined
Avg reimbursement
79 days
Strategic notes

Strong legacy relationship with regional medical director; preferred placement feasible

Peer set

Closest peers in Medicaid

Molina Medicaid New York
NY · Tier 4
41.1
+0.8
Pennsylvania Department of Medicaid
PA · Tier 4
43.4
+3.1
Sunshine State Health Alaska
AK · Tier 4
44.4
+4.1
WellCare of Florida
FL · Tier 4
45.4
+5.1
Molina Medicaid Louisiana
LA · Tier 4
45.7
+5.4
Playbook · Tier 4

Engagement timeline

Annually
Maintenance review · revisit tier