Skip all navigation Skip to page navigation

DHHS Home | A-Z Site Map | Divisions | About Us | Contacts | En Español

 
NC Department of Health and Human Services
Division of Medical Assistance Home
 
 

Payment Error Rate Measurement

In compliance with the Improper Payments Information Act of 2002, the Centers for Medicare and Medicaid Services (CMS) implemented a national Payment Error Rate Measurement (PERM) program to measure improper payments in the Medicaid program and the State Children’s Health Insurance Program (SCHIP) in each state.  North Carolina's second PERM review is scheduled for Federal fiscal year 2010 (October 1, 2009 through September 30, 2010).

CMS contracts with two Federal contractors to administer the PERM Program:

  • Livanta LLC (Livanta) is the statistical contractor (SC) and the documentation/database contractor (DDC)
    Livanta collects the claim universes from the States and selects a sample of fee-for-service and managed care claims to be reviewed from each State. Livanta also collects the Medicaid and SCHIP medical policies from each State, the provider medical records, and documentation from the provider-sampled claims.
  • HealthData Insights (HDI) is the review contractor (RC)
    HDI performs the medical and data processing reviews on the sampled claims to determine if the claims were paid correctly. At the end of the process, the SC calculates the State and National error rates for Medicaid and SCHIP based on the results of the RC's reviews and the eligibility case reviews conducted by the States.

Providers will be required to furnish the records requested within a prescribed timeframed indicated by the contractor. Provideres are urged to respond to these requests promptly upon receiving the request letter.

Records are required to be submitted by providers no late than 60 calendar days after issuance of the contractor's letter requesting such records (PERM Final Rule, Federal Register/Vol. 782, No. 169/Friday, August 31, 2007/Rules & Regulations, pg. 50496). A notice of proposed rulemaking (NPRM) for the 2010 PERM cycle is currently available in the Federal Register for public comment prior to being finalized in August 2009. All PERM information will be updated afer the Final Rule is published.

Providers are reminded of the requirement in Section 1902(a)(27) of the Social Security Act and Federal Regulation 42 CFR Part 431.107 to retain any records necessary to disclose the extent of services provided to individuals and, upon request, furnish information regarding any payments claimed by the provider for rendering services.

Provider cooperation to furnish requested records is critical in this CMS project. No response to requests and/or insufficient documentation will be considered a payment error. This can result in a payback by the provider and a monetary penalty for North Carolina Medicaid.

For More Information

 

November 3, 2009