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New Medicaid rules are coming. Stay enrolled. Update your contact information today.
New Medicaid rules are coming. Stay enrolled. Update your contact information today.

Behavioral Health Peer-to-Peer Process Change

Date: 10/07/26

Effective October 19, 2026, Meridian Medicaid Plan (Meridian) will align the behavioral health advisor review process with the existing physical health process. As part of this change, pre-determination peer-to-peer reviews will not be available for behavioral health authorization requests.

If an authorization request is denied, providers must follow the instructions in the denial letter to schedule a post-determination peer-to-peer review.

This process alignment is intended to streamline workflows, support timely completion of initial review requests, and enable facility and provider physicians to focus on member care when a consultation is not required for service approval.

What will remain the same

  • The overall medical necessity review process and notification timelines will not change
  • Post-determination peer-to-peer opportunities will remain unchanged, consistent with NCQA expectations

No immediate action is required. Please ensure your teams are aware of this change and prepared to follow the updated process beginning October 19, 2026.

For questions, please contact your Provider Engagement representative at ILProviderRelations@mhplan.com. If you do not have an assigned representative, please complete our intake form for assistance.