CommercialAdministrativeMedium impact
Revised Process for Physician Discussion and Determination
Medical Mutual of Ohio·In the News
Effective date
Aug 15, 2018
We identified it
Jun 20, 2026
Summary
Medical Mutual has revised their physician discussion process for adverse clinical determinations, requiring requests within 14 calendar days of denial (instead of after claims are processed) and limiting discussions to actively treating physicians only. This affects the appeals workflow for denied authorizations on commercial plans.
Action Required
Immediately: Update denial appeal workflow to schedule physician discussions within 14 calendar days of adverse determination. Only attending physicians, nurse practitioners, or physician assistants actively treating the member can request discussions. Use provided phone numbers: Medical/Surgical 1-800-338-4114, Behavioral Health 1-800-258-3186, Medical Drug Management 1-866-620-4027. Train staff that discussions must be scheduled in advance and are limited to one per denial.