Peer-to-Peer Discussion

Treating dentists who need an explanation of the clinical rationale for the denial of a dental procedure based on an adverse medical necessity or clinical appropriateness determination may request up to a half-hour peer-to-peer discussion with one of our dental consultants. Peer-to-peer discussions are not available for claim denials based on an exclusion, limitation, benefit exhaustion or other contractual provision of a patient's dental plan which does not require a medical necessity or clinical appropriateness determination. To request a peer-to-peer discussion, please complete the form below.

Upon receipt of your request, we'll reach out to you within 5 business days to schedule your peer-to-peer discussion. Please be prepared to provide at least two callback times
during the business hours of 9 a.m. to 3 p.m. Eastern Standard Time. A peer-to-peer discussion may be requested on behalf of a treating dentist by dental office staff, however the treating dentist must sign the request form and the peer-to- peer discussion must be conducted directly with the treating dentist.

Dentists not directly involved in providing the denied procedure(s) may not request or conduct the peer-to-peer discussion. A peer-to-peer discussion is not an appeal and will not result in a change in the initial denial of a dental procedure unless new information is presented that supports the medical necessity or clinical appropriateness of the denied procedure. Peer-to-peer
discussions are not available if an appeal of a denial has been submitted.