Get Performant Discussion Period Form

The Performant Discussion Period Form is an essential document used to initiate a discussion regarding audit decisions made by Performant Recovery, Inc. This guide will walk you through each section of the form, ensuring you have a clear understanding of how to complete it online.

Follow the steps to fill out the form correctly.

1. Click ‘Get Form’ button to access the Performant Discussion Period Form. This will open the document in your selected online editor.
2. Begin by filling in the provider or supplier's name in the designated field. This should be the name registered with Performant Recovery, Inc.
3. Enter the NPI (National Provider Identifier) in the appropriate section. This number is crucial for identification in the healthcare system.
4. Provide the TAX-ID number, ensuring it accurately reflects the provider or supplier's tax identification information.
5. Input the claim number associated with the audit. This number is essential for tracking your request.
6. Select the type of audit from the available options: Automated, Complex, or Semi-Automated. Include the relevant date(s) where applicable.
7. Indicate whether you have additional documentation attached by selecting 'Yes' or 'No'. If 'Yes', make sure to prepare the documents for submission.
8. Articulate your reasons for disagreeing with the RA’s decision in the designated text area. This is your opportunity to provide a detailed explanation.
9. Sign and date the form in the respective fields. Ensure that your printed name, phone number, and email address are also filled in.
10. After completing the form, you can save changes, download it, print it, or share it as necessary for submission.

Start filling out the Performant Discussion Period Form online today to address your audit concerns.