Peer to Peer Provider Notification Changes
Effective 10/1/2021, Optima Health will implement the following changes to the provider peer to peer and reconsideration process.
- The time allowed to complete a peer to peer with an Optima Health medical director has changed from 30 days to five days for government plans and from 45 days to five days for commercial plans.
- For government programs, the provider will no longer be allowed to only send in additional clinical documentation for a reconsideration. The provider must schedule a peer to peer with an Optima Health medical director to have their authorization reviewed again prior to appeal.
- Optima Health will allow peer-to-peer conversations for both Medicare lines of business.