Understanding the Peer-to-Peer Consultation Process
Date: 10/24/24
MHS Health Wisconsin values its network of providers and is committed to creating streamlined, effective processes that support the delivery of high-quality care. To better assist its provider partners, MHS Health has developed a document to guide providers in accessing both physical and behavioral health peer-to-peer consultation options available through the health plan.
By following the steps outlined below, providers can easily contact MHS Health to schedule peer-to-peer consultations and review authorizations with the health plan’s licensed medical directors.
Each line of business has been made easily accessible, and relevant information regarding peer-to-peer timelines is also provided.
Medicare Peer-to-Peer (P2P) Request Process | |||
Number | Notes | Action Steps | |
Physical Health
| Outpatient: N/A | No post decision P2P | Provider must initiate the appeal process stated in the denial letter |
Physical Health
| IP: 1-833-456-8216
| 2 days from denial letter or still IP | Call the direct number at 1-833-456-8216 |
Behavioral Health
| OP & IP: N/A
| No post decision P2P | Provider must initiate the appeal process stated in the denial letter |
Medicaid Peer-to-Peer (P2P) Request Process | |||
Domain | Number | Notes | Action Steps |
Physical Health
| Deadline: 5 business days from date of denial/or date of discharge, whichever is later.
| The provider calls the main number 1-800-547-1647: 1. Select prompt 3 for “Healthcare Provider”. 2. Select prompt 6 for “Authorizations”. 3. Select prompt 6 for “Peer to Peer”. The requesting provider can schedule the peer-to-peer at this time with all the required information.
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Behavioral Health
| Deadline: 5 business days from date of denial/or date of discharge, whichever is later.
| The provider calls the main number 1-800-547-1647: 1. Select prompt 3 for “Healthcare Provider”. 2. Select prompt 6 for “Authorizations”. 3. Select prompt 2 for “Behavioral Health Authorizations”. The peer-to-peer team member taking the information will call the requesting provider back to schedule the peer-to-peer.
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