New Claims System Update

Medical Director Calls (Peer-to-Peer)

The IntegraNet Health Medical Director will review cases where the potential for denial is raised furing the pre-authorization review process. In any instances where the medical necessity of the requested service is questioned by the Utilization Review Coordinator or Health Plan, the UM Medical Director will make a reasonable effort to contact the requesting and/or attending provider to afford to afford them to discuss the plan of treatment and the clinical basis for the decision, prior to final determination.
The discussion does not represent an appeal
For assistance, contact the Utilization Services at (281) 591-5289 or 888-292-1923