26-1172 Changes to Behavioral Health Peer-to-Peer Reviews

Date: 10/08/26

Pre-determination behavioral health peer-to-peer reviews end December 15, 2026

Effective December 15, 2026, pre-determination peer-to-peer (P2P) reviews for behavioral health authorization requests for Medi-Cal members will no longer be available.

What this means

Pre-determination P2P reviews will no longer be available before an authorization determination is made.

For denied authorization requests, post-determination P2P reviews will continue to be available and may be requested by following the instructions included in the denial letter.

What's not changing

• Medical necessity review criteria remain the same.
• Authorization review and notification timeframes remain the same.

Need help? Contact us

If you have questions regarding the information contained in this update, contact Provider Services at 844-966-0298.
 

This information applies to Behavioral Health Providers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.