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Discussion period request form

Medicare Forms To Sign, Complete,and Return 2026

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4.7 out of 5

55 votes

The document is a Discussion Period Request Form for providers/suppliers to request a 30-day period to submit additional information regarding claims that were reopened by the Recovery Audit Contractor (RAC) and deemed paid in error. It outlines the process for submitting the request, including necessary documentation, options for physician discussions, and contact information for assistance.

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Click ‘Get Form’ to open the Medicare Forms To Sign, Complete, and Return in the editor.
Begin by entering your Provider/Supplier Name, NPI, and TAX-ID in the designated fields. Ensure all information is accurate to avoid processing delays.
Fill in the CLAIM # and select the Type of Audit from the options provided: Automated or Complex. This helps categorize your request appropriately.
If you are requesting a Physician-to-Physician discussion, indicate 'Yes' and provide the name and credentials of the attending physician along with a detailed narrative explaining your request.
In the section for reasons against the RAC’s decision, clearly articulate your arguments. Use additional pages if necessary to ensure clarity.
Once all fields are completed, print the form for signing. Make sure to sign and date it before submission.
Submit your completed form along with any supporting documentation via mail or secure fax as instructed. If mailing, consider using a method that provides tracking.

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Versions	Form popularity	Fillable & printable
2020	4.7 Satisfied (55 Votes)
2013	4.6 Satisfied (42 Votes)
2013	4 Satisfied (40 Votes)

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discussion period request

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