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Performant discussion period request form 2026
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- Click ‘Get Form’ to open the performant discussion period request form in the editor.
- Begin by entering your Provider/Supplier Name, NPI, and TAX-ID in the designated fields. This information is crucial for identifying your account.
- Fill in the CLAIM# and select the Type of Audit from the options provided: Automated, Complex, or Semi-Automated. For automated audits, include the date of the MAC Demand Letter.
- Indicate whether you have additional documentation attached by selecting 'Yes' or 'No'. If you disagree with the RA’s decision, provide detailed reasons in the space provided.
- Sign and date the form at the bottom. Ensure that your printed name and phone number are clearly stated along with your email address for any follow-up communication.
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performant discussion request form
by KM Kirk 2017 Cited by 1 The RAC offers the provider a discussion period for all denied claims. Providers must contact the RAC within 15 calendar days of the date of the Demand Letter
The discussion will help you understand the structure of the application, the integration points, and how the parts of the application relate to each other.