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.