How TrueTier works
From raw claims data to smarter benefit decisions
TrueTier ingests your existing claims feed, applies evidence-based quality and cost scoring, and surfaces a clear provider tier structure — no new data collection required.
Connect your data
TrueTier integrates directly with your TPA or carrier claims feed via a secure, HIPAA-compliant data pipeline. We work with standard 837/835 EDI formats and most major TPA APIs — no custom extraction work on your end.
Typical integration time: 2–4 weeksScore providers on cost and quality
Our methodology combines risk-adjusted cost efficiency with evidence-based quality signals — board certification, complication rates, readmission rates, and peer-reviewed outcomes data — to produce a composite score for each provider in each specialty.
Updated monthly from claims + supplemental data sourcesBuild your tier structure
TrueTier maps providers into Tier 1 (high quality, cost-efficient) and Tier 2 (standard) designations. Your benefits team reviews and approves the tier assignments before any member-facing rollout.
Employer review and approval before go-liveActivate member incentives
Members access their personalized tier lookup tool — via web or mobile — and see their cost-sharing difference for Tier 1 vs. Tier 2 providers. Incentive design is configurable: lower deductibles, reduced copays, or premium credits.
Configurable incentive structures per specialtyMeasure and optimize
TrueTier's employer dashboard tracks utilization shifts, cost savings, and member engagement in real time. Monthly ROI reports show projected vs. actual savings, and our customer success team helps you refine tier assignments and incentive design each plan year.
Real-time dashboard + monthly ROI reportingOur data methodology
TrueTier's scoring model is built on peer-reviewed outcomes research and validated against independent quality registries.
Risk-adjusted cost efficiency
We normalize cost data for patient complexity using CMS Hierarchical Condition Categories (HCCs), so a provider treating sicker patients isn't unfairly penalized. Only true cost efficiency differences drive tier placement.
Evidence-based quality signals
Quality scoring draws from complication rates, readmission rates, length of stay, and board certification status — weighted by specialty. Weights are reviewed annually by our clinical advisory board.
Minimum volume thresholds
Providers must meet minimum case volume thresholds before receiving a tier designation. Low-volume providers are listed as 'untiered' rather than scored on insufficient data — protecting both members and providers from misleading rankings.
Transparent appeals process
Any provider can request a data review. TrueTier provides full scoring breakdowns and accepts supplemental data submissions. Tier designations are updated within 30 days of a successful appeal.
Built for transparency
We believe tiering only works when members, providers, and employers all trust the data. Every tier designation comes with a plain-language explanation of why a provider was placed in Tier 1 or Tier 2 — not just a badge.
See the methodology in action
Request a demo and we'll walk through a live scoring example using de-identified data from your specialty mix.