BCN changes process for requesting a peer-to-peer review for non-behavioral health cases

Effective Jan. 7, 2019, BCN is changing the process for requesting a peer-to-peer review discussion with a BCN medical director related to a non-behavioral health authorization request that was denied. This applies to both BCN HMO^SM (commercial) or BCN Advantage^SM members.

To get the details, please review the document How to request a peer-to-peer review with a BCN medical director, as follows:

• See Section 1 for how to request a peer-to-peer review for non-behavioral health cases. Instead of calling in the request, you'll now fax it in using the Physician peer-to-peer request form (for non-behavioral health cases).


• See Section 2 for how to request a peer-to-peer review on behavioral health cases. For these cases, the process is not changing. No form is used.

You can access both these documents — the process description and the form for non-behavioral health cases — on this website. Click BCN, then click Authorization Requirements & Criteria. Look under the "Referral and authorization information" heading.

The BCN Provider Manual will be updated to reflect this new information by the end of December.

Posted: December 2018
Line of business: Blue Care Network