← All glossary termsPeer-to-Peer Review
A conversation between a provider and a payer's medical director, typically triggered by an initial denial, to clinically justify a requested service or medication.
What it means
Peer-to-peer reviews add another layer of time and staff effort on top of the initial submission process, usually requiring a physician's direct involvement rather than administrative staff. Reducing the need for these reviews by getting first-pass submissions right is one of the clearest ROI arguments for accurate automation.
