Step by step
1
Request it fast
Peer-to-peer windows are short, often just a few days after the denial — schedule it immediately.
2
Pull the payer's coverage policy
Get the specific medical policy the denial cites so you argue against the actual criteria, not a guess.
3
Map your chart to each criterion
Line up the documentation that satisfies each element of the policy before the call.
4
Let the treating provider make the call
The physician who knows the patient argues clinical necessity far better than staff reading from a note.
5
Document the outcome
Record who you spoke with, what was decided, and any reference number — you may need it for a formal appeal if the P2P fails.
Common questions
Who should do the peer-to-peer call?
The treating provider. The payer sends a medical director, and the strongest argument comes from the physician who made the clinical decision and can speak to the specifics of the patient's case.
What if the peer-to-peer doesn't overturn the denial?
You still have the formal appeal path. Document the P2P thoroughly — the clinical points you raised become the backbone of a written appeal, and the failed P2P often satisfies a required review step.
Where Volari fits: When a peer-to-peer fails or wasn't offered, Volari builds the formal medical-necessity appeal from the documentation — the part that outlives the phone call.
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Volari AI · answers for independent practices · all answers →