Performant discussion period request form 2026

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  1. Click ‘Get Form’ to open the performant discussion period request form in the editor.
  2. Begin by entering your Provider/Supplier Name, NPI, TAX-ID, and CLAIM# in the designated fields. Ensure all information is accurate to avoid processing delays.
  3. Select the Type of Audit from the options provided: Automated, Complex, or Semi-Automated. For Automated and Semi-Automated audits, enter the Date of MAC Demand Letter as required.
  4. 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.
  5. Sign and date the form at the bottom. Include your Printed Name, Phone number, and E-mail for further communication.

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2020 4.7 Satisfied (55 Votes)
2013 4.6 Satisfied (42 Votes)
2013 4 Satisfied (40 Votes)
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