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Our experience indicates that discussions requested following audits can be handled more quickly and effectively if a written request and additional documentation are sent to us rather than receiving the request by phone.

We have also found that many of the requests, particularly when additional documentation is submitted to support the claim, can be resolved without the need for a teleconference.

To facilitate these changes, we have updated the PROVIDER REQUEST FOR DISCUSSION form.

To ensure that your request is addressed as early as possible, please be sure to send the documents to the appropriate location as shown on the Request for Discussion form.

Upon receipt of your request, the auditor and, if needed, the Medical Director will determine if a telephone discussion is necessary, or if a complete and appropriate response can be provided in writing based on the submitted documentation only. If a teleconference is necessary, you will be contacted to arrange a time. A letter will be sent detailing the outcome of each written or oral discussion.

The auditors involve the Medical Director(s) as appropriate throughout both the initial review and the discussion process, whether the discussion is completed as a written review or an oral teleconference.

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