How to Avoid Peer-to-Peer Phone Calls
As a doctor, we understand that your work day is full of challenges. The truth is, we know the old way of managing prior authorization can be cumbersome and inefficient. So that’s why we are changing things. Read and download the infographic below to learn tips on how to make the process of obtaining prior authorization easier and more efficient for clinicians and administrators.
The best way to avoid denials, appeals, and P2P phone conversations is to obtain prior authorization “right out of the gate" when your office's prior authorization employee (PAE) makes the initial request for an approval number. We have provided four very important keys to unlocking the complicated prior-authorization process. Our goal is to provide you with the tips, tools, and other necessary information to make the process easier for everyone.
How to Avoid
Peer to Peer
Phone Calls
The "Keys" to Prior-Auth
Key #1
Download EviCore’s Guidelines
Check out the EviCore guidelines. We use a rigorous process of accumulating and assessing the best available evidence, in accordance with the standards of our accreditation agencies (URAC and NCQA). In short, each chapter in the EviCore guidelines reflects the most current and authoritative evidence-based recommendations created by well-respected national organizations and made available to the public.
Key #2
Provide Clinical Information Up Front
To avoid denials and P2Ps, be proactive; anticipate and prepare the clinical information that EviCore will likely need, and provide that information to your prior-authorization employee to get approval during the initial request.
Reference EviCore's Quick Reference Guides to learn about what information we will need for various types of requests.
Key #3
Prepare for Clinical Questions
The fastest and most reliable way to avoid P2P phone calls and other appeals and obtain the prior authorization number “right out of the gate" on the very first submission is to be prepared to answer the clinical questions that will be asked.
Key #4
Refer to the Guidelines
Paste the EviCore guidelines on your desktop and refer to them whenever you are uncertain about the best imaging study request when you are treating your patients.
