New Offset Request - RAC DME Form
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New Offset Request - RAC DME Form

To streamline processing of offset requests related to Recovery Audit Contractor (RAC) overpayments, NAS has created a unique offset request form and established a dedicated fax line to receive these requests.

NAS encourages suppliers to fill out the new Offset Request - RAC DME form when requesting that future claims payments be applied to overpayments intiated by Health Data Insights (HDI), the Recovery Audit Contractor (RAC) for Jursidication D.

The form may be faxed to the dedicated RAC offsets fax line 1-866-640-9459.  Suppliers are requested to include a copy of the related overpayment letter from HDI with the offset request.

Form: https://www.noridianmedicare.com/dme/forms/

Instructions: https://www.noridianmedicare.com/dme/forms/rac_info.html

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