Peer-to-peer review for ambulatory surgery centers
When a payer denies a prior authorization and requires physician-to-physician review, Approva manages the entire process — scheduling, clinical brief preparation, surgeon readiness, and outcome documentation.
Scheduling and payer coordination
Approva identifies when a denied case qualifies for peer-to-peer review and initiates scheduling with the payer's medical director. The system tracks review windows, follows up on scheduling confirmations, and flags cases at risk of missing the appeal deadline — so no review opportunity is lost to administrative delays.
Clinical brief preparation
Before the call, Approva assembles a structured clinical brief for the reviewing surgeon. The brief includes the original denial reason, relevant clinical criteria from the payer's policy, supporting documentation from the chart, and a summary of the clinical rationale. Surgeons enter the peer-to-peer call prepared — not pulling records on the fly.
Outcome tracking and escalation
After the review, Approva records the outcome against the case and updates the authorization status. Reversed decisions are confirmed and the case proceeds to scheduling. Upheld denials are routed to the next level of denial management — whether a formal appeal or external review. Every step is documented for audit and for improving future prior authorization submissions to that payer.