Peer-to-Peer Discussion

Treating dentists who need an explanation of the clinical rationale for a negative determination of a dental procedure based on an adverse medical necessity, client clinical provision, 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 provisions of a patient's dental plan which does not require a medical necessity, clinical review, or clinical appropriateness determination. To request a peer-to-peer discussion, please complete the form below. A practitioner may receive one peer-to-peer discussion per episode of treatment unless the practitioner has new, pertinent information that is applicable to a second conversation.

To request a peer-to-peer discussion, please complete all fields in the form below. Upon receipt of your request, we'll reach out to you within 30 calendar 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 actual peer-to- peer discussion must be conducted with the treating dentist. Dentists not involved in the provision of the related dental services may not request or conduct the peer-to-peer call. 

A peer-to-peer discussion is not considered a reconsideration or appeal and will not result in a change to the original determination.