Get Performant Discussion Period Request Form

This guide provides a clear and supportive overview of how to accurately complete the Performant Discussion Period Request Form online. By following these steps, users can ensure that they provide the necessary information for their request effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the form by entering your provider or supplier name in the designated field. This is your official business name.
3. Enter your National Provider Identifier (NPI) number. This is a unique identifier for healthcare providers.
4. Fill in your Tax ID number, which is required for tax purposes.
5. Provide your claim number in the specified field to identify the relevant claim for which you are requesting a discussion.
6. Indicate the type of audit by selecting from the options provided: Automated, Complex, or Semi-Automated. Ensure you fill in any additional dates as needed based on the selected type.
7. Indicate whether you have attached additional documentation by selecting 'Yes' or 'No.' If necessary, provide brief details about the attached documents.
8. Clearly state the reasons for disagreement with the Recovery Auditor’s decision in the space provided. Ensure to be detailed, and if necessary, submit additional pages.
9. Sign and date the form in the designated fields to authenticate your request.
10. Enter your printed name, phone number, and email address for further communications.
11. Once you have filled out all necessary fields, you can save changes, download, print, or share the form as needed.

Complete your Performant Discussion Period Request Form online today for a streamlined process.