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Peer-to-peer review request scheduling

Use this form for Medicaid peer-to-peer (P2P) requests.

Other requests

  • The online P2P Scheduling Tool is currently only for Medicaid P2P review requests, not determinations by eviCore or Pharmacy.

  • For authorization requests you submitted through NantHealth, call 1-866-968-7482. Then, choose option “3." 

P2P provider information

Type the requestor’s first and last name .
Type the requestor’s phone with 10 digits like this: 123-456-7890.
Type the requestor’s email in this format: abc@xyz.com.
Type 10 digits like this: XXXXXXXXXX.
NPI type (optional) (Choose one type for your NPI.)
Type the provider’s first and last name.
Type the provider’s group facility or name.
Type the provider’s phone with 10 digits like this: 123-456-7890.
Type the provider’s cell phone with 10 digits like this: 123-456-7890.
Type the provider’s email in this format: abc@xyz.com.

 

Patient and authorization information

Type the member’s first and last name.
Type the member’s date of birth like this: 12/04/1998.
Type the 12-digit authorization number like this: 241023456789.
Type the denial notification date like this: 12/04/1998.

 

Provider availability (required)

Provide at least 3 dates and times that you have open. Our medical directors are here for you 8 AM to 5 PM CT, Monday to Friday.


Privacy Policy and Terms of Use (required)

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