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Peer-to-peer review request scheduling

Use this form for Medicaid peer-to-peer (P2P) requests.

Other requests

  • For MMAI requests, call 1-855-711-3801. 

  • The online P2P Scheduling Tool is currently only for Medicaid P2P review requests, not determinations by eviCore or Pharmacy.

  • For authorization requests you submitted through NantHealth, call 1-866-968-7482. Then, choose option “3." 

P2P provider information

Your network status
Fill in the requestor’s first name. 
Fill in the requestor’s last name. 
Fill in the requestor’s phone with 10 digits like this: 123-456-7890 .
Fill in the requestor’s email like this: abc@xyz.com. 
Fill in the provider’s NPI number with 10 digits like this: XXXXXXXXXX. 
NPI type (optional) (Choose one type for your NPI.)
Fill in the provider’s first name. 
Fill in the provider’s last name. 
Fill in the provider’s group facility or name.
Fill in the provider’s phone with 10 digits like this: 123-456-7890. 
Fill in the provider’s cell phone with 10 digits like this: 123-456-7890. 
Fill in the provider’s email like this: abc@xyz.com. 

 

Patient and authorization information

Fill in the member’s first name. 
Fill in the member’s last name. 
Fill in the member’s date of birth like this: 12/04/1998.
Fill in the authorization number with 12 digits like this: 241023456789.
Fill in the denial notification date like this: 12/04/1998.

 

Provider availability (required)

 

Provide at least 3 dates and times that you have open. Our medical directors are here for you 8 AM to 5 PM CT, Monday to Friday.

Add the first date and time you are free to chat.
Add the second date and time you are free to chat.
Add the third date and time you are free to chat.


Privacy Policy and Terms of Use (required)

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