Inpatient peer-to-peer policy update coming Sept. 4, 2024
Effective Sept. 4, 2024, and in alignment with industry standards, inpatient peer-to-peer reviews (P2P) will only consider the clinical information submitted with the initial authorization request. We’ll classify any additional information submitted after the initial denial as a level 1 appeal and cancel the P2P request.
As a reminder, we offer two levels of appeal for medical authorization denials.
Be thorough with inpatient authorization requests
We recognize that, when admitting a patient to the hospital, you may need multiple days to appropriately assess and document their condition and care plan. This is why we don’t require you to notify us within 24 hours if one of our members is hospitalized. Additionally, we don’t require authorization for observation stays regardless of the length of hospitalization.
By ensuring all supporting documentation is available and submitted with the initial authorization request, you can avoid potential re-work and appeals. We’re seeking to work with you, our providers, in getting you the best decision the first time.
Get more information
Review our full P2P policy for additional information, including request timelines, when P2Ps aren’t available, how to request a P2P and more.