Peer-to-peer review scheduling

How do we book a peer-to-peer review inside the payer's window, with the clinician's availability captured and the case summary ready for the call?

Treat the payer's peer-to-peer offer as a deadline with two things to collect. When a payer offers a peer-to-peer on a denied or pended authorization, Callvu prefills the case (the request, the payer's reasons, the criteria cited, the clinical documents sent, the payer's window and scheduling channel), asks the ordering or treating clinician on their phone for their availability inside the window and the points they want to make, assembles a one-page case summary from the chart against the payer's criteria, chases the clinician until the availability is given and the payer until the call is confirmed, records the booking with the payer's reference, and after the call captures the outcome from the clinician so the authorization process continues with the decision.

In scopeComplex: multi-party handoffsCallvu moves: prefill, chase and verify

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Last updated November 7, 2026.

The problem today

The payer's window was three business days; the offer sat in a fax queue for two of them, and the surgeon learned of the call an hour before it.

Today, without Callvu

A peer-to-peer review is the fastest way to overturn a denial: a clinician explains the case to the payer's medical director. It is also the easiest to lose. The offer comes with a window of days; it arrives in a portal, a fax or a letter; the clinician's schedule is full; the authorization coordinator plays phone tag with the payer's scheduling line; the window closes and the case goes to a written appeal that takes weeks.

The payer's rules set the window, the scheduling method and who may conduct the call (often a physician of the same specialty); the clinician needs the payer's reasons and the criteria to prepare; the outcome has to be recorded for the authorization and any later appeal. The booking is a chase against two parties with a deadline, which is exactly what a process should own.

A call booked inside the window, with a summary in the clinician's hand, is the authorization's best chance.

How it runs

From the requestto the system of record.

A payer offers a peer-to-peer on a denied or pended authorization (through the prior authorization or renewal process). Callvu opens the booking with the payer's window.

Ordering or treating clinician: Gives their availability and the points they want to make on their phone, takes the call, and records the outcome.
Authorization coordinator: Sees the booking's status and handles payer scheduling exceptions.
Payer's scheduling line or portal: Confirms the call time and the reviewer.
Callvu: Prefills the case, captures the availability, assembles the summary, chases both parties, records the booking and the outcome.

Prefill the case and the window
The authorization request, the payer's denial or pend reasons and the criteria cited, the documents already sent, the payer's peer-to-peer window and its scheduling method (a phone line, a portal slot, a callback request) and the reviewer requirements are prefilled from the authorization record; the window's end is the deadline on the booking.
Chase and verify the clinician's availability
The clinician receives the offer on their phone with the payer's reasons, the window and a request for availability slots inside it and the points they want to make; the availability is chased on the clock, and a clinician who cannot take the call is asked to name a covering physician the payer's rules allow.
Assemble the summary and book
A one-page case summary is assembled from the chart against the payer's criteria (the diagnosis, the findings the criteria name, the treatment tried, the clinical rationale, the clinician's points), reviewed by the clinician on their phone; the call is requested from the payer through its method with the clinician's slots, the payer is chased until the time and the reviewer are confirmed, and the booking is recorded with the payer's reference and sent to the clinician's calendar with the summary attached.
Record the outcome
After the call, the clinician records the outcome on their phone (overturned, upheld, modified, more information requested) with any payer reference; the outcome is written to the authorization record in the EHR so the prior authorization or renewal process continues (the approval written back, or the appeal started on its deadline), and a missed or rescheduled call re-opens the booking inside what remains of the window.

Where it ends: The peer-to-peer was booked inside the payer's window with the clinician's availability and a summary built against the criteria, and the outcome reached the authorization record so the next step started without delay. The Decision Trace shows the window, the availability and the summary; the Audit Trace shows each chase, the confirmation and the outcome with time.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

Payer utilization management and peer-to-peer rules, and the state utilization review laws: Payers' utilization management programs (and the NAIC Utilization Review Model Act and state laws modeled on it) provide that an adverse determination may be discussed with the reviewing physician, set the window in which the peer-to-peer must be requested or held (commonly a few business days from the denial), the scheduling method, and that the reviewer be a physician, in many states of the same or a similar specialty; a peer-to-peer does not usually extend the appeal deadline, so both clocks run.
CMS prior authorization rule (CMS-0057-F) and the Medicare Advantage utilization management rules (42 CFR 422.566 and 422.629): The covered payers must give the specific reason for a denial, which the clinician receives with the offer, and Medicare Advantage plans must have a physician with appropriate expertise review a denial based on medical necessity; the peer-to-peer is the provider's opportunity to present the clinical rationale before the reconsideration.
HIPAA Privacy Rule minimum necessary standard (45 CFR 164.502(b)): The case summary and the discussion disclose the protected health information needed for the payment decision and no more.

Company policies

The payer's window is the deadline on the booking from the moment the offer arrives; the offer never waits in a queue.
The clinician receives the payer's reasons and a summary against the criteria before the call.
The outcome is recorded by the clinician and reaches the authorization record the same day.
The EHR authorization record is the system of record for the booking and the outcome.

Controls

Case and window prefill from the authorization record.
Clinician availability capture with covering physician option.
Case summary assembly against the criteria.
Payer scheduling chase and confirmation.
Outcome capture and write to the authorization record.
Re-open on a missed call inside the window.

Clocks and deadlines

Peer-to-peer window: The payer's period from the denial to request or hold the call; the booking's deadline.
Appeal deadline: The payer's appeal period, running in parallel and visible on the record.
Outcome: Recorded the day of the call so the next step starts.

Documents and checks

The offer with the payer's reasons and window
The clinician's availability and points
The case summary
The booking confirmation with the payer's reference
The outcome on the authorization record

In the Decision Trace

The window and the scheduling method.
The summary's mapping to the criteria.
The outcome.

In the Audit Trace

The offer receipt with time.
Each chase of the clinician and the payer with time.
The confirmation and the outcome with time.

The handoff

Between the front doorand the back office.

The front door

The clinician's phone for availability, the summary and the outcome.

The back office

The coordinator sees the booking's status against the window and handles only payer scheduling exceptions.

The Decision Desk

A clinician who cannot take the call inside the window, or a payer that will not confirm, goes to the authorization lead in the Decision Desk with the window and only name a covering physician, escalate with the payer, or proceed to the written appeal.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

23 hospitals in the Ministry of Health network run on Callvu.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

How long does the clinician have?

The payer's window from the denial, commonly a few business days; it is the booking's deadline from the moment the offer arrives, and the appeal deadline runs in parallel.

What does the clinician get before the call?

The payer's reasons and criteria, and a one-page summary from the chart mapped to them with their own points, on their phone.

What happens after the call?

The clinician records the outcome on their phone, it reaches the authorization record in the EHR the same day, and the approval is written back or the appeal starts on its deadline.

Related processes

Scheduled-procedure prior authorization Authorization renewals and extensions Medication prior authorization Try it in the sandbox All healthcare processes

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