Provider peer-to-peer request form

If this is an urgent request, please call the AmeriHealth Medical Director’s Office at 215-241-0494. For all out-of-area requests, please call 1-888-814-2244. All non-urgent calls will be returned within 24 hours.

If the member has a Medicare Product, please contact the Peer to Peer line for additional information at local 215-241-0494 or OOA 1-888-814-2244 (option 3).

If this was denied by AmeriHealth pharmacy or Optum Rx, contact Members Appeals at 1-888-671-5276, for the Peer to Peer request.

Please complete all information requested on this form.

(* required fields)

Patient information


Requesting physician information

Only a NP/PA/LCSW/MD can complete a Peer to Peer with the MDR