Peer-to-Peer (P2P) Consultation

When a prior authorization request does not meet evidence-based medical guidelines, the patient’s provider who submitted the prior authorization request can schedule a phone call with an EviCore medical director to discuss the patient’s medical condition. These are called peer-to-peer discussions, and they allow for the exchange of additional clinical information. These discussions may result in upholding the original decision that a request is inappropriate or issuing an alternative recommendation. The original decision that a request is inappropriate may also be overturned due to additional information being provided and the request being approved during the peer-to-peer. These discussions often result in a more informed decision about whether to do a certain test, treatment, or procedure.