Peer-to-peer calls, handled physician to physician
Short answer
Aerolib physician advisors prepare for and conduct peer-to-peer conversations with payer medical directors when an admission or service is denied or under review. We gather the clinical facts, frame the medical necessity argument and speak physician to physician, so your attending doesn't have to fit the call into a full clinical day.
Reviewed by board-certified physician advisors
When to request a peer-to-peer
- An inpatient admission is denied or downgraded to observation
- A prior authorization is denied
- The payer offers a P2P window before a formal appeal
How we prepare
- Review the record and the payer's stated reason
- Match the case to the payer's criteria and CMS rules
- Build a short, clinical argument for the call
- Document the outcome and next step, including appeal if needed
Tools behind it
- P2P simulation7+ practice scenarios at 3 difficulty levels against a simulated medical director
- Payer behavior profilesCall strategies and denial tendencies by state and payer, 50 states
- Physician advisor accessText or call for P2P prep, same-day response
Common questions
What is a peer-to-peer review?
A phone conversation between the treating side's physician and the payer's medical director to discuss a denial or pending decision before it becomes final or goes to appeal.
Who makes the call, our doctor or yours?
An Aerolib physician advisor can make the call for your hospital, or prepare your attending if the payer requires the treating physician.
What happens if the peer-to-peer doesn't overturn the denial?
We move to a written appeal with the clinical rationale and applicable rules. See denial appeals.
Talk with a physician advisor
Tell us about your hospital and we'll set up a call with one of our physician advisors.