UM Operations
Peer-to-Peer Review
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Only appropriately licensed clinical reviewers may make adverse medical-necessity determinations; the peer-to-peer is where that clinical judgment meets the treating clinician's. Operationally, easy scheduling of peer-to-peers is one of the highest-leverage provider-abrasion fixes in UM.