Payment Error Rate Measurement Information for Medicaid & CHIP Providers Regarding Medical Record Requests

The Payment Error Rate Measurement (PERM) program measures improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) and produces error rates for each program. The PERM error rates are based on reviews of fee-for-service (FFS), managed care, and eligibility components of Medicaid and CHIP in the federal fiscal year (FFY) under review. It is important to note the error rate is not a “fraud rate” but simply a measurement of payments made that did not meet statutory, regulatory or administrative requirements. Beginning in late calendar year 2017, CNI Advantage, LLC, the federal review contactor (RC) under PERM, will be reaching out to Medicaid and CHIP providers whose claims have been selected for review in a sample measurement conducted under the 2017 PERM project.  If a claim from your office has been selected for review, you will be receiving a call from a CNI Advantage, LLC representative to verify the appropriate contact and address to mail and/or fax the medical records request pertaining to the sampled claim.  Once this information is verified, the medical records request will be sent to that contact person requesting all medical records pertaining to the sampled claim. Records must be submitted to CNI Advantage, LLC within seventy-five (75) calendar days from the date you are contacted.  If the requested supporting medical documentation is not submitted, the claim will be coded as an error and any monies paid will be recouped.  Since dollars estimated as being paid in error are projected to all claims, the actual impact of each claim error will be magnified several times, resulting in an overall and exponentially negative impact on the Florida Medicaid program.