A peer-to-peer review is a conversation between the hospital's physician and the payor's medical reviewer about a disputed medical necessity decision. It can be the fastest route to resolving a denial or a disputed level-of-care decision, and it goes better with the clinical record organized and the right physician in the conversation.
bServed coordinates that involvement through its physician advisors, who are engaged on borderline and disputed cases and on denials that need to be contested.
What's Included
- Peer-to-peer review coordination with physician advisors
- Proactive physician advisor engagement before denial risk escalates
- Physician advisor involvement for all borderline or disputed cases
- Physician advisor escalation for cases approaching criteria thresholds
- Complete, payor-aligned clinical packets prepared in advance
Before the Conversation: Know the Criteria
A peer-to-peer goes further when the physician knows exactly which criteria the payor applied. For Medicare Advantage plans, that question has a regulatory side: see When Medicare Advantage Denies a Continued Stay, Ask Which Criteria It Used.
Peer-to-Peer as Part of Denial Prevention and Recovery
Physician advisor involvement works best early, before denial risk escalates, which is the focus of Hospital Denial Prevention. When a denial does occur, the same physicians support Appeals & Denial Recovery.
Related Services
Appeals & Denial Recovery
Fast, clean packets submitted within eligibility windows.
Hospital Denial Prevention
Resolving denial risk before the claim is filed.
Medical Necessity Review Services
Criteria-aligned clinical reviews using InterQual and MCG.
Related reading: When Medicare Advantage Denies a Continued Stay, Ask Which Criteria It Used · Concurrent Review vs. Prior Authorization vs. Retrospective Review