Peer-to-Peer Review Process for Antipsychotics

Date: 08/15/16

Superior offers Peer-to-Peer (P2P) reviews with a Cenpatico Behavioral Health medical director for providers whose patients have been denied a psychotropic medication. Superior will send providers and patients a written notification if a decision to deny, reduce, suspend or stop coverage of a psychotropic drug is made. The denial notice will also explain how to file an appeal and how to contact Superior if assistance is needed.

Once a denial notification is received, providers may request a P2P review, or for a decision to be overturned, from Cenpatico Behavioral Health. When submitting requests, new and pertinent clinical information must be provided such as lab or test results received after the initial prior auth request or contraindications to preferred medication not previously noted.

During a P2P review, Superior offers providers an opportunity to discuss adverse determination decisions with a Cenpatico medical director or an appropriate practitioner reviewer. In urgent cases, an expedited appeal is available and can be submitted verbally or in writing. Note: Reviews are limited to prior authorization denials on psychotropic medications only.

To coordinate a P2P review, providers may email a Cenpatico medical director at SHP-CenpaticoPA@cenpatico.com.

Providers may also request a review by calling Cenpatico Behavioral Health at 1-866-349-5794, Monday – Friday, 7:30 a.m. – 6:00 p.m., CST.

Please be sure to include the member’s name, ID number, date of birth and any pertinent clinical information for the review.