Peer-to-peer discussion

When a Blue Cross and Blue Shield of Nebraska (BCBSNE) physician reviewer denies a certification request for medical necessity, the attending physician or ordering provider has the right to discuss the decision with them prior to requesting an appeal. (If the BCBSNE physician who made the denial is not available, the attending physician will be given the opportunity to discuss the case with a different physician reviewer.)  

Peer-to-peer discussion appointments may be made by calling 800-424-7079. We will need the reference number and the patient’s member ID number.   

Requests for peer-to-peer reconsiderations of not medically necessary denials on prospective and concurrent reviews must be requested within 14 calendar days of the denial. If a peer-to-peer request is not received within 14 calendar days of the denial, the provider will need to submit a request for an appeal.  

The BCBSNE physician reviewer discusses a case only with the attending physician, not with the patient. The peer-to-peer discussion will occur within one business day of the attending physician’s request.  

If the attending physician or ordering provider disagrees with our decision, they are encouraged to discuss the case with our physician reviewer. It is important to include any additional information we did not have when the original denial was issued.  

If the attending physician or ordering provider declines the peer-to-peer discussion or if the peer-to-peer discussion does not resolve a difference of opinion, the attending physician has the right to request an appeal.