Changes to the peer-to-peer and reconsideration processes

Effective December 1, 2024, reconsideration and peer-to-peer requests can occur at any time during the review process, but no later than three business days after an initial denial letter has been issued and no reconsideration or peer-to-peer review has occurred. A reconsideration or peer-to-peer for an urgent pre-service or urgent concurrent request must be completed within one business day of receipt of the request. Non-urgent pre-service or post-service reconsideration and peer-to-peer requests must be completed within three business days of receipt of the request. If the request for reconsideration or peer-to-peer is made outside of the appropriate time frame, the provider will be instructed to follow the formal medical necessity appeal process as indicated within the initial denial letter.

For more information about this change, please contact Provider Services at 800-901-0020. To schedule a peer-to-peer review, call 833-621-2129, select two for provider and one for peer-to-peer request.

Website: www.anthem.com/vamedicaiddoc