Get Performant Recovery Discussion Period Request Form 2020-2026

This guide provides a clear and supportive overview on how to effectively fill out the Performant Recovery Discussion Period Request Form online. Whether you are a seasoned provider or new to the process, the following steps will help you navigate the necessary components efficiently.

Follow the steps to successfully complete your request form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering your provider or supplier name in the designated field at the top of the form. Ensure that the name is accurate as it is vital for identification purposes.
3. Fill in your National Provider Identifier (NPI) number. This unique identifier is crucial for processing your request.
4. Enter your taxpayer identification number (TAX-ID). This is necessary for verification and processing.
5. In the claim number section, input the specific claim number that you wish to discuss.
6. Select the type of audit that applies to your claim by checking the appropriate option: automated or complex.
7. If you have additional documentation to support your case, indicate 'Yes' or 'No' as appropriate.
8. Specify if you are requesting a Physician-to-Physician discussion by selecting 'Yes' or 'No.' If yes, provide the name and credentials of the physician attending the call.
9. Clearly articulate the reasons why you disagree with the recovery audit contractor's decision in the provided space.
10. If more space is needed, attach additional pages as necessary to ensure all relevant information is included.
11. Sign and date the form where indicated. This is an important step for validating your submission.
12. Finally, save all changes and proceed to download, print, or share the completed form as per your needs.

Take the first step and start filling out your Performant Recovery Discussion Period Request Form online today.