Notice to Providers Who Have Not Submitted or Submitted Incomplete PERM Audit Information

On October 1, 2014, Delaware started a new cycle of the Payment Error Rate Measurement (PERM) Program required by CMS. The PERM program measures improper payments in Medicaid and DHCP in the Federal Fiscal Year (FFY) under review. The error rates are based on reviews of the fee-for-service (FFS), managed care, and eligibility components of Medicaid and DHCP. All states are required to participate every three years on a rotating basis. The PERM Project is well underway and Medical Record (MR) requests are going out to Providers from A+ Government Solutions, a contractor hired by CMS to complete the medical record review. Providers must submit proper medical record documentation supporting the paid claim(s) selected within 60 days of the request. The required documentation must include sufficient information to validate that services were provided, were medically necessary, and were consistent with the specified diagnosis during the time of claim payment. The MR requests will continue quarterly throughout 2015 and 2016 on a rolling basis.