Provider Additional Documentation Submission Requirements
Medical Record (MR) Submission Requirements (Paper/CDs or DVDs)
• Please note that the additional documentation and medical records for Prepay audits are due within 30 days, Post pay audits are due within 45 days from the date of the additional documentation request letter.
• Please be sure all documentation submitted is legible.
• Please submit only requested documentation as identified in the letter and documentation that specifically supports the procedures/codes billed for all dates of services related to the claim. If not requested please omit before sending.
• All Blank pages should be OMITTED (Note: Provider will not be paid for blank pages)
See below for specific requirements:
CDs or DVDs Medical Records:
- Scanned image resolution must be clear and legible. 300 dpi and in black and white.
- Image format must be in either PDF or TIFF format though PDF is preferred
o For PDF format, DO NOT password protect the individual PDF files. Instead, zip all PDFs into a WinZip file and encrypt it.
o CD/DVDs do not require encryption but it is recommended for security purposes. If encryption/password protection is desired, the following common WinZip options are accepted:
Zip 2.0 compatible encryption
256-Bit AES encryption
- If a password is required to open a zipped CD/DVD please submit that password to Performant Recovery , Prior to shipment, via one of the methods below. Must include a record identification reference (reference number/claim number/audit number) for identification.
- Call (866) 201-0580 and provide password to a Provider Service Representative
- E-mail password to info@PerformantRac.com
NOTE – Do not leave the password on the Performant Recovery voice mail
Performant Recovery Inc.
2819 Southwest Blvd
San Angelo, TX 76904
• Please visit the following CMS web page for background on esMD.
• Scanned image resolution must be clear and legible. 300 dpi and in black and white.
• Image format must be in either PDF or TIFF format though PDF is preferred
• For PDF format, DO NOT password protect the individual PDF files.