MedicaidPrior AuthMedium impact
24-343 Follow These Guidelines When Requesting a Peer-to-Peer Review With a Medical Director to Discuss An Adverse Determination
Health Net·CA·Prior Authorization
We identified it
Jun 20, 2026
Summary
New policy establishes specific guidelines for requesting peer-to-peer (P2P) reviews with medical directors after adverse prior authorization determinations. Providers have 5 business days to request P2P review by calling 818-676-5503 with required member information, but cannot use P2P for appeals, post-discharge situations, or after the 5-day deadline.
Action Required
Immediately: Update prior authorization workflows to include P2P review option. Train staff to call 818-676-5503 within 5 business days of adverse determinations with required information: member name, DOB, case number, medical director name, nurse name, and member ID. Post phone number and requirements in prior auth department. Note that P2P cannot be used for appeals, post-discharge cases, or beyond 5 business days.