Department of Public Health and Human Services

Home » Quality Assurance Division » Program Compliance » PERM

Main Content

PERM

Payment Error Rate Measurement

FFY 2017 (PERM) Program

The Payment Error Rate Measurement (PERM) program measures improper payments in Medicaid and CHIP to produce a National Error rate for each program.  The error rates are based on reviews of the fee-for-service (FFS), data processing, and eligibility components of Medicaid and CHIP in the Federal Fiscal Year (FFY) under review.  PERM does not measure fraud; it determines the amount of claims paid in error based on our states policies and program requirements.

Today’s PERM audit process was developed through the establishment of many acts.

  • Improper Payments Information Act (IPIA) 2002 required federal agencies to review programs susceptible to erroneous payments.
  • Improper Payments Elimination and Recovery Act (IPERA) of 2010 amended the IPIA and required additional processes to identify improper payments.
  • The Improper Payments Elimination and Recovery Improvement Act (IPERIA) 2012 amended the IPERA and required additional process to recover and reduce improper payments.

The Centers for Medicare and Medicaid Services (CMS) administers and oversees the PERM audits.  States are organized into 3 groups or cycles.  Montana is a Cycle 3 state.  Other Cycle 3 states include;  Alaska, Arizona, District of Columbia, Florida, Hawaii, Indiana, Iowa, Louisiana, Maine, Mississippi, Nevada, New York, Oregon, South Dakota, Texas, and Washington.

CMS uses two contractors to perform the PERM reviews.  The Lewin Group is responsible for collecting the claim data from the State of Montana and pulling a random sample.  Chickasaw Nation Industries (CNI), Inc. is responsible for conducting the reviews.  Providers will be contacted from CNI, Inc.

When a claim is initially selected for review, providers receive 75 days to submit documentation to support the claims billed.  If additional documentation is needed to review the claim, providers are given 14 days to submit the verifications.  If providers fail to turn in all of the requested documentation, the claim will be considered an error and an overpayment may be recouped by the State of Montana.  If the documentation provided does not support the claim as billed, the claim will be considered an error and an overpayment may be recouped by the State of Montana.

Providers will not receive notification if a claim is found to be correct.

Introduction to PERM

PERM Process

CMS PERM Provider page

For more information about PERM

State of Montana
PERM /IPV Supervisor
Eligibility Review Contact

Heather Smith
(406) 444-4171
HeatherSmith@mt.gov

Medical Record and Data Processing Review Contact
Krista Cronholm
(406) 444-9365
KCronholm@mt.gov

PERM Medical Review Contractor:
CNI, PERM Review Contractor
1300 Piccard Drive, Suite 204
Rockville, MD  20850
Phone: (301) 987-1100
Fax: (301) 417-8040 or (877) 619-7850