Maine is currently participating in a PERM audit for Reporting Year 2021 which covers randomly selected paid claims with a payment date from July 1, 2019 through June 30, 2020.
PERM is a federally contracted audit process that measures improper payments in Medicaid and Children's Health Insurance Program (CHIP) and produces error rates for each program. Error rates only indicate that a payment made did not meet statutory, regulatory, or administrative requirements; these are not fraud rates.
Financial Impact of Errors and Lack of Documentation
All errors are considered improper payments. Maine is required to reimburse the federal government for all improper payments and has the right to seek recoupment from those providers. See the PERM Audit: Common Errors (PDF) for errors found during the Fiscal Year (FY) 2017 PERM audit cycle.
- PERM Quarterly Audit Resume E-Message - August 18, 2020
- PERM Quarterly Audit Pause E-Message - August 5,2020
- PERM Quarterly Audit E-Message - May 7, 2020
- PERM Quarterly Audit E-Message - February 6, 2020
- Record Request Documentation Guidelines (PDF) - Guidelines for record requests documentation.
CMS has contracted three organizations to administer the PERM audit:
- Medical Review Contractor: NCI, Inc. (formerly Advance Med, Inc.)
- Statistical Review Contractor: The Lewin Group
- Eligibility Review Contractor: Booz Allen Hamilton
Centers for Medicare and Medicaid (CMS) Information
- CMS PERM Overview - General overview of the PERM program.
- CMS PERM Laws and Regulations - Includes laws and regulations governing PERM.
- CMS PERM Provider's Page - Contains resources including a Frequently Asked Questions link, records request information, and a Claim Category Matrix which describes the documentation that may be requested and is organized by provider type of service.
- PERM: Responding to Medical Records/Documentation Requests - A video produced by CMS in 2014.
- For questions about medical records requests, including questions on the terminology used in some of the communications from NCI, Inc. (formerly Advance Med, Inc.), please contact the NCI, Inc. Medical Records Manager. The contact information is printed on the bottom of the documentation request letter that you received.
- You can email CMS with general questions on the federal PERM program and provider specific at PERMProviders@cms.hhs.gov. Please DO NOT send medical records to this contact.
- Please contact Kealoha Rosso by phone at (207) 624-6929 or email at email@example.com for State of Maine-specific questions. Please DO NOT send medical records to this contact.