A peer-to-peer (P2P) discussion is a telephone conversation between a licensed BridgeSpan physician and the health care provider to discuss a denial (e.g., related to a behavioral, non-behavioral or provider-administered medication) resulting from a medical necessity review determination. During the P2P, our physician and the provider will discuss the member’s circumstances relative to appropriate clinical criteria and our policies.
P2P discussions may only happen before an appeal has been submitted and only for services that are denied for medical necessity or investigational reasons. A P2P discussion can only be requested for:
- Pre-service denials
Concurrent denials
To ensure that the provider has received the denial rationale and has been informed of the criteria used for the review, a P2P discussion must be requested:
- After the provider has received the determination letter and
This form must be submitted within 15 calendar days of the date on the denial letter. Tip: For concurrent reviews, we recommend submitting a peer-to-peer review request within 48-72 hours of the denial.
To request a P2P discussion, please contact our Provider Contact Center.
No additional information will be accepted as part of the discussion. If the provider disagrees with our decision or has additional information to submit, the provider may submit an appeal following the appropriate process.
Note: All medication-related calls will be routed to a BridgeSpan clinical pharmacist. If there are questions that the clinical pharmacist is unable to answer, the clinical pharmacist will schedule a call with a BridgeSpan medical director.