Get Cotiviti Discussion Request Form 2017-2025

The Cotiviti Discussion Request Form is an essential document for providers wishing to discuss review results with Cotiviti. This guide will walk you through the online process to complete and submit this form effectively.

Follow the steps to complete the Cotiviti Discussion Request Form online.

1. Press the ‘Get Form’ button to access the Cotiviti Discussion Request Form and open it in your online document handler.
2. Ensure you fill out the form electronically, as handwritten forms are not accepted.
3. Clearly state your reasons for the discussion request in the designated box. Be as specific as possible to facilitate a thorough review.
4. Provide your contact information, including your fax number, phone number, and email address, to ensure effective communication.
5. Enter the relevant claim number in the ICN field and the dates of service in the required format (mm/dd/yyyy).
6. Sign and print the completed form, ensuring that it is signed by an authorized representative.
7. Once completed, save your changes and print the document to keep a copy for your records.
8. Submit the form as required, making sure it is the first page of any supporting documentation you include.
9. If applicable, include additional records to support your reasoning for the request.
10. After submission, monitor your inbox or preferred communication method for responses from Cotiviti.

Complete the Cotiviti Discussion Request Form online today for timely assistance.