Inactive
Notice ID:APP-240179-PERMRC
The PERM program will produce national level improper payment rates for Medicaid and CHIP as required by the PIIA. The PERM national contracting strategy has been designed to allow for the concentrati...
The PERM program will produce national level improper payment rates for Medicaid and CHIP as required by the PIIA. The PERM national contracting strategy has been designed to allow for the concentration of assignments, fluidity among tasks, and timely completion of all tasks necessary to complete the Medicaid and CHIP PERM measurement. Therefore, it is imperative that all contractors maintain open communication with CMS and with each other and work collaboratively to establish and maintain processes that allow timely and accurate completion of work. The general operating procedures for the Medicaid and CHIP PERM program are as follows: The Statistical Contractor (SC) will initiate the start of a PERM cycle by contacting the selected states and obtaining the necessary claims universe information for sampling purposes; selecting statistically valid samples from the states’ universes of claims; and requesting and receiving claims details from the states. The Review Contractor (RC) will research, then collect and request state Medicaid and CHIP medical policies from the states; request and receive medical records from the providers; perform the medical reviews; collect claims payment policies, fee schedules and processing system manuals for data processing review; and provide web-based calls for orientation to RC PERM processes to perform data processing reviews. The RC will visit state offices and/or remotely perform data processing reviews. The RC also hosts and maintains the State Medicaid Error Rate Findings (SMERF) system. The Eligibility Review Contractor (ERC) will perform the eligibility review functions for the PERM measurement of Medicaid and CHIP including conducting PERM eligibility reviews for beneficiaries on sampled payments; communicating eligibility findings with states and CMS; and supporting state and national reporting.
