Peer-to-Peer Telephone Line
To discuss a medical determination with a physician in the AmeriHealth Caritas North Carolina Medical Management department, providers may call the Peer-to-Peer telephone line by following the prompts at 1-833-900-2262. Providers must call within two business days of notification of the determination or within two business days of the member’s discharge from an inpatient facility.
The purpose of the Peer-to-Peer process is to address medical determinations regarding health care services. This process is not intended to address denied claims or other issues. For information on filing a provider grievance or appeal, please refer to the "Provider and Network Information" section of the Provider Manual. For information on disputing a claim, please refer to the "Claims Submission Protocols and Standards" section of the Provider Manual.
Filing an appeal on behalf of a member
A provider may file an appeal on a member's behalf, with the member's written consent. To file an appeal as an authorized representative on behalf of a member, a provider may call 1-855-375-8811.