Behavior Analysis Peer-to-Peer Request Form
Please use the form below to submit your request for a Peer-to-Peer review for Behavior Analysis (BA) services ONLY. Peer-to-peer review meetings may take up to two weeks to be scheduled from the time of submission. To help us process your request efficiently, please ensure all fields below are completed accurately.
- Timeliness of Requests: Peer-to-Peer requests must be submitted within 48 hours of the denial letter date. Requests made after this timeframe will not be scheduled. In such cases, please proceed with submitting an appeal. See denial letter for appeal instructions.
- Scheduling Timeframe: Please be advised that Peer-to-Peer discussions are currently being scheduled approximately two weeks out from the date of request.
- Document Submission: If additional documentation is needed to support the authorization, it must be uploaded to the portal prior to submitting the Peer-to-Peer request. Documents submitted after the request will not be reviewed.
- Appropriateness of Peer-to-Peer Discussions: If services were denied in whole or in part due to missing documentation, a Peer-to-Peer discussion is not appropriate to resolve the issue.
- The suggested times provided on the form are not an appointment. An email or faxback confirmation will be provided within two business days. It will include the date and time of your appointment.
- Once you are scheduled, a provider or provider advocate must be available at the date and time provided on the confirmation. If you are unable to keep the appointment, please advise 24 hours prior to the scheduled appointment, so we can reschedule for the next available agreed upon date and time.