Physician Tiering Reporting

Maine Bureau of Insurance
Physician Performance Measurement,
Reporting, and Tiering Programs
Registration Form

General Instructions

Title 24-A MRSA §2694-A requires each insurer implementing or utilizing a physician performance measurement, reporting or tiering program to annually provide to the Superintendent a statement of the criteria, standards, practices, and procedures governing such a program. 

Please complete the following form by October 1 of the current year.  Applicants may be asked to provide such other information as the Bureau of Insurance may reasonably request. 

Null/Exempt Report

If the insurer believes that it is exempt from this requirement, or that it has nothing to report related to utilization of a physician performance measurement/reporting/tiering program, please state the reason in box # 1. Once this reason is described, the rest of the form need not be completed.

If you have questions about completing the form, please contact Violet Hyatt at or (207)-624-8550. 

General Information

All fields with * after them are required fields. You cannot submit your report until all required fields are completed.


Physician Performance Measurement or Tiering Program Reporting Requirements (Summaries)

Physician Performance Measurement or Tiering Program Reporting Requirements (Full Statement)

5. Please provide full and true statements of: the criteria, the standards, and the practices and procedures used to measure physician performance or tier physician performance.  Please either provide a link to its location on your website, or send us PDF files.  Forward any PDF files to As required by Title 24-A M.R.S.A. §2694-A(1), these statements must be verified by the oath of the insurer’s president or vice president, and secretary or chief medical officer, and the statements and supporting information are public records even if they might otherwise be protected as trade secrets or some other class of privileged information.