Ambetter Has Updated The Timeframe For A Peer-to-Peer Discussion Request

Fecha: 30/11/23

Effective January 15, 2024, Ambetter of Illinois will update the timeframe for a peer-to-peer discussion request to five (5) calendar days after an initial denial notification. 

A peer-to-peer discussion is an opportunity for a treating physician to discuss medical criteria and guidelines with the health plan medical director. Medical directors review cases based on medical information submitted to the health plan. Treating physicians who want to discuss a utilization review determination with the decision-making medical director may do so at any time during the review process by contacting the Ambetter coordinator at 833-456-8216, option 4.