MedicaidAdministrativeMedium impact
25-539 Mark Your Calendar: New Peer-to-Peer Request Line Launches July 12, 2025
Health Net·CA·Prior Authorization
Effective date
Jul 12, 2025
We identified it
Jun 20, 2026
Summary
Community Health Plan of Imperial Valley is launching a new dedicated peer-to-peer review request line (833-236-9715) effective July 12, 2025, providing live support during business hours and next-day callbacks for after-hours requests. The policy clarifies that peer-to-peer reviews cannot be requested for appeals, post-discharge situations, or more than 5 business days after an adverse prior authorization determination.
Action Required
By July 12, 2025: Update prior authorization workflow to use new peer-to-peer review phone number 833-236-9715. Train staff on required information needed for requests: member name, DOB, case number, medical director name, nurse name, and member ID. Ensure staff understand 5-business-day deadline for requesting peer-to-peer reviews after adverse determinations and that requests must be made before patient discharge for concurrent reviews.