Peer to Peer Telephone Line
To discuss a medical determination with a physician in the AmeriHealth Caritas Delaware Medical Management department, providers may call the Peer-to-Peer telephone line by following the prompts at 1-855-396-5770. 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 an informal provider complaint, 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 1-855-396-5770.