Browse Healthcare & Medical Professionals SECTION 7: Insurance, Coding & Prior Authorisation

The Peer-to-Peer Review Preparation

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The Peer-to-Peer Review Preparation

Prepare me for a peer-to-peer review call with a payer's medical
director.

Requested item: [DESCRIBE]
Denial reason given: [PASTE]
My clinical case: [DESCRIBE, DE-IDENTIFIED]
Time available on the call: [MINUTES]

Produce:
1. A 60-second opening statement — the strongest version of my case
2. The three facts that must be stated regardless of how the call
   goes
3. Likely objections and a direct response to each
4. The guideline or criterion to cite, by name
5. Questions to ask them: what specifically would satisfy the
   criterion
6. How to keep the call clinical rather than administrative
7. What to document immediately afterwards
8. Next step if the call is unsuccessful

Write the opening statement as words I would actually say.

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