RARC N939: Peer-to-Peer Review Available
Informational alert: the payer is inviting a peer-to-peer conversation between the treating clinician and its medical director, typically following a medical-necessity or utilization decision. Check for a deadline and route it to the right clinician promptly.
What Does RARC N939 Mean?
N939 signals that the payer is offering a peer-to-peer review as a next step, rather than simply issuing a final determination and closing the loop. Peer-to-peer review is a direct clinical conversation, usually by phone, between the ordering or treating provider and a physician or medical director on the payer's side, focused on the clinical reasoning behind a service, admission, or level of care. It's most commonly extended after a utilization review or medical-necessity determination where the payer's initial read of the documentation led to a denial or a reduced determination, and the payer is giving the clinician a chance to supply context that may not have come through clearly in the written record.
This remark is distinct from a standard appeal in that it's a clinical discussion rather than a paperwork-based reconsideration process, and it often happens on a faster timeline than a formal written appeal. In many payer workflows, a peer-to-peer conversation can happen before, or in parallel with, filing a formal appeal, and the outcome of that conversation can sometimes resolve the issue without the case needing to go through the full appeals process at all. Because the value of a peer-to-peer discussion depends entirely on a clinician who can speak knowledgeably to the specific case, this is not something the billing department can typically handle on its own — it needs to be routed to the physician or other qualified provider who was directly involved in the patient's care.
Peer-to-peer opportunities are usually time-limited, though the exact window varies by payer and by the type of determination involved. Missing that window can mean losing the option to have the conversation at all, leaving a formal written appeal as the only remaining path.
What to Do
Identify any deadline referenced on the remittance or in the payer's related correspondence for scheduling the peer-to-peer call, and treat that date as a hard cutoff for action. Route the request immediately to the treating or ordering clinician (or whichever provider is clinically positioned to discuss the case), along with the relevant chart documentation, so they can prepare before contacting the payer's medical director.
Track the scheduling and outcome of the peer-to-peer call in the account notes, since the conversation may resolve the determination directly or may simply inform the strategy for a subsequent formal appeal. If the deadline is tight or clinician availability is a constraint, contact the payer promptly to confirm the scheduling process and, where possible, secure a call time rather than letting the window lapse by default.
Common Scenarios
- An inpatient stay is denied for medical necessity following utilization review, and N939 invites the attending physician to discuss the clinical picture directly with the payer's medical director before a formal appeal is filed.
- A prior authorization denial for an advanced imaging study includes N939, and the ordering physician calls the payer's peer-to-peer line to explain findings from the physical exam that supported the order.
- A billing office receives N939 on a remittance but the deadline passes before the request reaches the ordering physician, forcing the practice to proceed directly to a formal written appeal instead.
- A denial for a specific level of care during an admission includes N939, and the peer-to-peer conversation results in the payer reversing its determination without a written appeal being necessary.
Commonly Paired With
No common pairings documented yet.