Updated process for peer-to-peer reviews starts July 1
Starting July 1, you'll have one phone number to call if you want to schedule a peer-to-peer conversation with a medical director for inpatient and outpatient services to help you work with us quickly and easily. The phone number is 616.464.8432.
We've also expanded our hours of operations. You can contact us Monday—Friday, 8:30 a.m. - 4 p.m. There's no change to the process for behavioral health services. Behavioral health providers should continue to call 616.464.8500.
What is a peer-to-peer review?
The purpose of peer-to-peer discussion is to exchange information regarding the medical necessity of a denied prior authorization request. The call does not take the place of documentation required to support authorization.
How do I request a peer-to-peer review?
You must schedule a peer-to-peer review within certain time frames, which vary depending on the authorization type.
|Type of denial||Timeframe to request peer-to-peer reviews||How to schedule||When we're available|
|Outpatient services, equipment or elective inpatient admissions||15 calendar days from the date of denial notification||616.464.8432||8:30 a.m. – 4 p.m., Monday through Friday, excluding holidays|
|Inpatient urgent/emergent admissions or long-term acute care hospital (LTACH)||5 calendar days from the date of denial notification|
|Acute/sub-acute rehab, skilled nursing facility (SNF)|