Peer-to-peer (P2P)
A live discussion between a treating clinician and a plan reviewer that may clarify the denial rationale or evidence needed; availability and effect on appeal rights vary by plan.
Peer-to-peer is a direct phone consultation between the prescribing clinician and the plan's reviewing clinician (typically a medical director). It's often offered before or alongside the formal internal appeal. The reviewing professional has authority to overturn or uphold the denial in real time based on the clinical conversation. P2P is most effective for prior-authorization denials of biologics, oncology drugs, mental-health treatments, and advanced imaging.
Frequently asked questions
What is peer-to-peer (p2p)?
Peer-to-peer is a direct phone consultation between the prescribing clinician and the plan's reviewing clinician (typically a medical director). It's often offered before or alongside the formal internal appeal. The reviewing professional has authority to overturn or uphold the denial in real time based on the clinical conversation. P2P is most effective for prior-authorization denials of biologics, oncology drugs, mental-health treatments, and advanced imaging.
Related terms
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