Peer to Peer Consults

 

The information in this article is only applicable to Humana authorizations.

Our goal is to reduce the need for peer-to-peer consults. However, we know that in some situations, the best way to get patients the care they need quickly is to connect our physicians with yours for a brief conversation. Click here to print the details about the peer-to-peer process at Cohere.

Cohere's approach

  • Minimize the need for peer-to-peer consults with automatic approval of clinically appropriate prior authorization requests.
  • Have productive conversations with providers to help the patient get the care they need, not issue a denial.

What makes us different

  • Conversations are scheduled before an adverse determination is made. 
  • Physicians have the opportunity to withdraw the case prior to Cohere issuing a denial. This prevents a “denial” notice from being issued to the patient and allows the provider to manage communication. If appropriate, the provider can then submit a new request. 
  • Cohere’s panel of peer-to-peer physicians are board-certified physicians who are experienced both on the giving and receiving end of peer-to-peer consultations. We will match a peer-to-peer physician with the same specialty as the ordering physician.

How it works

When an authorization is queued for a peer-to-peer request, we will make 3 attempts to contact someone at your office and schedule. All outreach attempts will be through the method indicated below (fax, phone, and/or email) unless that method is unavailable to us. 

1st & 2nd attempt

  • Who receives the outreach? The requester who submitted the authorization
  • How is the outreach attempted? Fax & email; depending on the contact information available to our team.
  • When are the attempts made? At the SAME time* *if both outreach attempts are made in the same way (email/fax), the second attempt will be sent:
    • 4 hours after the 1st outreach for Medicare standard
    • 1 hour after the 1st outreach for Commercial/ Medicare Expedited

3rd attempt

  • Who receives the outreach? The requester who submitted the authorization
  • How is the outreach attempted? Phone
  • When are the attempts made?
    • Medicare standard: 4 hours after 1st & 2nd outreach
    • Commercial standard: 1 hour after 1st & 2nd outreach
    • Expedited: 1 hour after 1st & 2nd outreach
On the 3rd attempt, we will offer the option of scheduling a peer-to-peer. Once a denial has been issued, we can no longer offer a peer-to-peer. At that time, you must go through the Humana appeals process.
Have more questions?
Submit a request