PayerIQ
Production
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Tier 2NJBCBS

Blue Cross Blue Shield Wyoming

Active pursuit — access summits + value dossier

Composite
61.5
Rank
#112
Members
3.8M
Scoring profile

Six-criterion radar

Breakdown

Weighted score contribution

Claims
25%
100
+25.0
Lives
20%
34
+6.8
Geography
20%
54
+10.8
Restrictions
15%
31
+4.6
Relationship
10%
69
+6.9
Financials
10%
73
+7.3
Composite Score61.5
Composite = Claims×0.25 + Lives×0.20 + Geography×0.20 + Restrictions×0.15 + Relationship×0.10 + Financials×0.10
= 25.0 + 6.8 + 10.8 + 4.6 + 6.9 + 7.3 = 61.5
Intelligence

Qualitative intelligence

Members
3.8M
Drug spend
$1.1B
Formulary
2-tier
PA / RA level
Low
Biosimilar policy
Mandatory substitution
Avg reimbursement
33 days
Strategic notes

Large dual-eligible population; PA/RA process requires clinical evidence package

Peer set

Closest peers in BCBS

Anthem Blue Cross Blue Shield of Maine MCO
CT · Tier 2
61.6
+0.2
Blue Cross Blue Shield Nebraska HMO
ME · Tier 2
61.1
-0.3
Blue Cross Blue Shield Montana
VA · Tier 2
62.4
+0.9
Blue Cross Blue Shield of Kansas
NV · Tier 2
60.5
-0.9
Blue Cross Blue Shield of Georgia
NH · Tier 2
62.9
+1.4
Playbook · Tier 2

Engagement timeline

Week 1
Senior medical director engagement
Week 3
Formulary review submission
Quarterly
Account QBR + utilization review