Peer-to-peer reconsideration requests for Medicare members
For Medicare members, any request to change an initial adverse plan decision must be handled through the appeals process — not through peer-to-peer discussion. For a pre-service decision, a provider may request a peer-to-peer discussion as part of an optional, informal process designed to encourage dialogue between the requesting provider and Priority Health. However, this process cannot be used to request a reconsideration of the initial adverse decision.
See Medicare reviews and appeals for more details.