[Appeal] peer-to-peer review: what to say and what to bring
Something I noticed reading old threads that I have not seen said out loud.
The advice on step therapy in this community changed substantially around the start of last year, and nobody went back and updated the older posts. So depending on which thread the search engine hands you, you get two contradictory answers with the same confidence.
I have listed what I think the current consensus is below. Correct me — that is the point of posting it.
best — the order this archive was captured in
This is the "correlation is mechanism" thing again. You changed three variables at once.
say which country and which plan type
denial reason codes matter, ask for the actual code
Denied for prior auth, resubmitted with copay documentation, approved on appeal. The criteria exist, you just have to meet them.
Which plan type? copay is different.
denial reason codes matter, ask for the actual code