UM Update: Changes to Peer-to-Peer (P2P) Process
Effective April 1, 2026, Partners Health Management is renaming and revising its post-decision Peer-to-Peer (P2P) process to align with National Committee for Quality Assurance (NCQA) guidelines. The process will now be referred to as Post-Decision Discussions.
The purpose of a Post-Decision Discussion is to have a collaborative conversation to clarify the rationale for the decision, allow the treating provider to share additional clinical information, provide education on applicable policies or clinical criteria, and review next steps.
What is changing?
Effective April 1, 2026, Partners is revising the P2P process and renaming it Post-Decision Discussions to align with NCQA guidelines:
- The term “Peer-to-Peer” will no longer be used following an adverse determination.
- Discussions will not result in a change to the original decision.
- Requests must come from the treating provider.
- The discussion will occur with the original peer reviewer or another qualified designee.
- These discussions do not pause or extend appeal timelines.
- Parents, guardians, members, or other representatives may not request these discussions on behalf of the provider.
What do providers need to know?
Post-Decision Discussions are collaborative conversations meant to clarify the reason for the decision, and allow the treating provider to share additional clinical information. These discussions are also an opportunity to provide education on applicable policies or clinical criteria and review next steps.
Providers should know:
- Discussions must be requested within five business days from the date on the adverse notice.
- Verbal discussion alone will not change or reopen a decision.
- Any additional clinical information intended to support a change must be submitted through a member appeal or a new service request.
- Appeal rights and prior authorization requirements remain unchanged.
What do providers need to do?
Providers need to:
- Submit Post-Decision Discussion requests within five business days of the notice date.
- Ensure the request comes directly from the treating provider.
- Continue to follow all standard appeal processes for reconsideration of decisions.
Who can providers contact with questions?
For questions, contact the Appeals Department at 1-704-884-2650 or email Appeals@PartnersBHM.org.