25-540 Mark Your Calendar: New Peer-to-Peer Request Line Launches July 12, 2025
Date: 05/30/25
The new line provides efficient and dedicated support to assist you
Effective July 12, 2025, peer-to-peer review scheduling will be streamlined so most calls are answered live during business hours and after-hours calls are returned within one business day. The new peer-to-peer line is 833-236-9715.
How to request a peer-to-peer review
Call the above number with the necessary information available to request a peer-to-peer review. If you reach a voicemail, please leave a message with the required information and a callback phone number. The medical director's team will contact you to schedule a peer-to-peer review.
Required information
- Member name
- Member date of birth
- Case number
- Medical director name
- Name of the nurse who worked the case
- Member identification number
Reminder: peer-to-peer reviews may not be used in certain situations
Please note, the peer-to-peer review does not apply to:
- Appeals. Once you or a member submits an appeal, you cannot request a peer-to-peer review. If the member submits the appeal for an adverse determination you have issued, we will reach out to you for any additional information you may have.
- Post-discharge. For adverse concurrent review determinations, you must request a peer-to-peer review prior to the member’s discharge. Once the member has been discharged from a facility, you cannot request a peer-to-peer review. If a member is discharged on the weekend, please call prior to discharge and leave a message for your peer-to-peer request to be considered timely. Beyond this time, an appeal may be filed.
- Initial adverse determinations beyond five business days. You have five business days to request a peer-to-peer review following issuance of an adverse prior authorization determination. Beyond this time, an appeal may be filed.
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Provider Services
Line of business | Phone number |
|---|---|
Ambetter from Health Net IFP Ambetter PPO | |
Ambetter HMO | |
Health Net Employer Group HMO, POS, & PPO | |
Medicare (Individual & Employer Group) (Wellcare By Health Net) | |
Medicare Supplement | |
Medi-Cal (including CS and ECM providers) |
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.