How the grade is computed
PayerScore grades each payer (a health insurer, Blue Cross Blue Shield plan, or third-party administrator) on a 300 to 850 scale, per state, where a lower grade means the payer treats providers worse. It is a modeled index and an opinion derived entirely from disclosed public data.
What goes in
- Federal IDR dispute records (CMS Public Use File): how often providers win independent-dispute-resolution against the payer, how far above the payer's own qualifying payment amount (QPA) the winning awards land, and how often the payer defaults or fails to respond. These are federal dispute records, not court judgments.
- Documented public rate positions: where the payer's published contracted rates sit versus the local peer median, for the codes we can compare (an optional enhancer, present only where the public rate record is deep enough).
How it is scored
Each signal is oriented so higher badness pushes the grade down, shrunk toward the national baseline for small samples, and mapped deterministically to 300 to 850 (grade = 850 minus 550 times a 0 to 1 badness composite). Dispute volume is used only as a confidence weight, never as a score input: a payer is not graded worse simply for facing more disputes.
What we publish
The public board shows a curated set of major, nationally recognizable carriers where the public record is deepest and cleanest. Every published grade requires at least 30 resolved federal disputes; below that, or for a payer we do not yet feature, the page shows an honest "insufficient / not featured" state and is not indexed. Nothing is ever fabricated.
Corrections
A payer may request a correction or dispute a grade at corrections@reddenda.com. Methodology version 1.0.0.