Please clarify the procedure that a provider may follow if they disagree with the DCS determination and wish to discuss the account with DCS concerning the denial?
The RAC discussion period begins with receipt of the review results letter for complex reviews or the demand letter for automated reviews. If a provider has any questions after receiving a letter they should contact DCS immediately to ask questions. The discussion period continues until the issue is resolved or recoupment is complete. This period is for the provider to contact DCS via telephone or written inquiry using the discussion form , and provide additional information they feel may support their original claim or request clarification from DCS as to why the denial was issued. Question: If a provider is in the discussion period with the RAC, is the appeal still due on day 31? What are the exact details and rules we must follow in regard to rebutting a decision during the discussion period? Answer: Yes the appeal is still due on day 31. Although the discussion period falls into the time frame when the provider can file an appeal, it is distinctly separate from the appeals process.
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