Reminder: Call backs aren't available for missed peer-to-peers for inpatient cases

We’re sharing a reminder that call backs to our medical director team aren’t available for missed peer-to-peer (P2P) calls for inpatient cases.

While we’d previously allowed call backs, this practice resulted in after-hours communication with our medical director team and, in some instances, calls about cases that didn’t yet have a P2P scheduled. Because this practice was unsustainable, in early 2023, we removed the call-back function for inpatient cases. (Note: Call backs are allowed for missed P2Ps for outpatient cases, due to lower volume and more latitude for rescheduling than with inpatient cases.)

Should you miss a scheduled P2P call for an inpatient case, you have the option to either:

#1. File a medical necessity appeal

This option is outlined in our P2P policy and is the most appropriate next step in most cases. We offer Level 1 and Level 2 medical necessity appeals – find instructions in our Provider Manual, for Medicare cases and non-Medicare cases.

#2. Discuss at your next P2P (for back-to-back appointments only)

In some cases, you may have multiple P2P appointments scheduled back-to-back – for example, at 11:15 a.m., 11:30 a.m. and 11:45 a.m.

• If you miss the first P2P call at 11:15 a.m., our medical director team will leave a message stating, “I will be calling you back at 11:30 a.m. for our next scheduled P2P. If time allows, we can discuss the 11:15 a.m. P2P. Thank you.”, and call back at 11:30 a.m.
• If time allows during the 11:30 a.m. appointment, you may discuss the missed P2P case at that time. If there isn’t enough time or if the subsequent call is missed, a medical necessity appeal is the next available step.
• If you miss two back-to-back P2P calls, all remaining P2P calls during the scheduled block of time (i.e., 3rd / 4th calls etc.) are forfeit – our medical director team won’t call at the remaining scheduled times.