FEP Peer-to-Peer Review Request

Purpose of the Peer-to-Peer (P2P)

Use this form to request a peer-to-peer review (P2P) of a medical necessity, cosmetic or investigational denial related to a pre-service, concurrent review or post-service, member liability review.
The P2P process is not for contract exclusions which do not require medical review or reimbursement issues.
A peer-to-peer is not intended to overturn a denial or replace an appeal.
Please contact our Provider Customer Service Team by phone if you have any questions.

Criteria for Request

This form must be submitted within 15 calendar days of the date on the denial letter.
For non-Medicare members, a P2P request will not be accepted if an appeal has already been submitted.
P2P requests must be requested by the member's treating, ordering, or covering provider with knowledge of the member's condition.
If the answers to all the questions below are yes, a P2P may be conducted.

If you would like to request a P2P to discuss the denial of a physician-administered medication, please submit the Pharmacy Peer-to-Peer Review Request Form.

Please note that all medication-related calls will be routed to a Regence clinical pharmacist. If there are questions that the clinical pharmacist is unable to answer, they will schedule a call with a Regence Medical Director.

If the request does not meet these criteria and you wish to submit an appeal, please refer to the denial letter.

Fields marked with an asterisk (*) are required.

Questionnaire

Is this request for a medical necessity, cosmetic or investigational denial related to a pre-service or concurrent review or post-service, member liability review?

Pre-service requests are prior to provider services.
Concurrent review is usually for a current facility stay.
We send notification letters regarding post-service, member liability denials that are eligible for P2Ps. We do not offer P2P for denials of other services that have already been provided - those are handled through the appeal process.

Please select yes or no*

Does the physician understand options to appeal, and that most appeals for medical necessity denials have specialty-matched review of all information submitted?

Please select yes or no*

Do you understand that a P2P is a discussion (not an appeal) about a case to further understand the reason(s) for the denial based on our policies? A P2P is not intended to overturn a denial.

Note: New information about the service must be submitted as an appeal.

Please select yes or no*

Is the provider who will be speaking with our medical director the patient's treating, ordering, or covering provider with knowledge of the patient's condition?

Please select yes or no*

Is this the first P2P you have requested for this patient and service?

Note: Additional P2Ps are ONLY allowed for new/different denial on current reviews (i.e., a request to extend an inpatient hospital stay).

Please select yes or no*

Do you understand that a P2P request will not be considered if an appeal has already been submitted?

Note: P2P requests for Medicare members will be considered regardless of whether an appeal has been submitted or not.

Please select yes or no*

Provider information

First name and last initial of individual submitting this form*

Office or direct phone number for coordination*

Does this number have a secure and confidential voice mail?*

Yes

Please provide a secure email address for P2P confirmation

Provider first name*

Provider last name*

National Provider Identifier (NPI)*

Preferred provider phone number for P2P call (pager numbers not accepted)*

Does this number have a secure and confidential voice mail?*

Yes

Are there any special phone instructions to reach the attending/covering physician

Federal Employee Program medical peer-to-peer (P2P) review request

Questionnaire

Is this request for a medical necessity, cosmetic or investigational denial related to a pre-service or concurrent review or post-service, member liability review?

Does the physician understand options to appeal, and that most appeals for medical necessity denials have specialty-matched review of all information submitted?

Do you understand that a P2P is a discussion (not an appeal) about a case to further understand the reason(s) for the denial based on our policies? A P2P is not intended to overturn a denial.

Is the provider who will be speaking with our medical director the patient's treating, ordering, or covering provider with knowledge of the patient's condition?

Is this the first P2P you have requested for this patient and service?

Do you understand that a P2P request will not be considered if an appeal has already been submitted?

Member information

Provider information

Provider availability - please read carefully

Helpful Information - Provider Customer Service