Sometimes a requesting provider may disagree with an adverse determination and wish to discuss the decision with the clinician who made the denial. Other times, the requesting provider may wish to discuss the merits of a request with an HCP Medical Director prior to having the determination made.
In either circumstance, the easiest way to schedule a call is to contact the Peer-to-Peer line at (516) 394 – 5790.
Note that for Medicare products, all calls requested AFTER a decision has been rendered by an HCP Medical Director Reviewer and subsequently communicated to the provider, the provider’s office or to the member, either verbally or in writing, HCP cannot, by regulatory standards, change a determination decision. You must file a formal appeal following the instructions included in the denial statement that is mailed to your office.
For Commercial and Medicaid products, you may request a reconsideration within the timeframe specified in the decision notification by contacting the HCP Peer-to-Peer line at (516) 394 – 5790.