About PERM
In response to the Improper Payments Information Act of 2002, the federal Office of Management and Budget identified Medicaid and the Children's Health Insurance Program (CHIP) at risk for significant improper payments. As a result, the Centers for Medicare and Medicaid Services (CMS) developed the Payment Error Rate Measurement (PERM) program.
The PERM program uses a three-year rotation to produce and report national Medicaid and CHIP improper payment rates. This information is shared with Congress. There are three cycles, each containing 17 states (50 states and the District of Columbia). Pennsylvania is part of Cycle 1. The PERM Audit takes approximately two and a half years to complete.
The Department of Human Services' (DHS) PERM team consists of representatives from the Office of Medical Assistance Programs (OMAP), Office of Income Maintenance (OIM), Office of the Budget, Office of Long-Term Living (OLTL), Office of Developmental Programs (ODP), CHIP, and Office of Administration (OA). The Bureau of Program Integrity, under OA, manages the PERM process for Pennsylvania and serves as the liaison between DHS, CMS, and the federal contractors.
The RY 2022 PERM audit was Pennsylvania's last completed PERM cycle. The Commonwealth audit outcomes are listed below, along with the National Rolling Error Rates and the Cycle 1 Error Rates. The Commonwealth outperformed many other Cycle 1 states, as well as national level.
Rate | Overall % | FFS % | MC % | Eligibility % |
|---|---|---|---|---|
RY 2022 PA Medicaid Rates | 2.49% | 0.93% | 0.00% | 2.36% |
2022 National Rolling Medicaid Rates | 15.62% | 10.42% | 0.03% | 11.89% |
RY 2022 Cycle 1 Medicaid Rates | 6.64% | 3.72% | 0.00% | 5.36% |
RY 2022 PA CHIP Rates | 5.58% | 0.00% | 2.50% | 3.16% |
2022 National Rolling CHIP Rates | 26.75% | 11.23% | 0.62% | 24.01% |
RY 2022 Cycle 1 CHIP Rates | 11.49% | 2.44% | 0.68% | 10.46% |
2022 PERM Audit Reports
Listed below are the final reports received from CMS for the RY 2022 PERM Audit for PA:
- 2022 Medicaid Cycle Summary Report PA
- RY 2022 Medicaid Error Notification
- RY 2022 Medicaid Error Notification (Recalculated)
- 2022 CHIP Cycle Summary Report PA
- RY 2022 CHIP Error Notification
Provider Information
*Note all Provider information will be updated as it becomes available.
Provider Quick Tips related to PERM
Medical Records Request
Providers can expect Medical Record Request Letters from Empower AI, Inc. to begin in June 2024. Below are examples of correspondence you may receive from CNI.
- Sample RY 2025 Initial Record Request Packet
- Sample 2025 Request for Additional Information Packet
- RY 2025 Claim Category Matrix
Federal Contractors Conducting the PERM Audit
Name | Address | Phone | |
|---|---|---|---|
Statistical Contractor (SC) | |||
The Lewin Group | 3160 Fairview Park Drive, Suite 600 | (703) 269-5500 | |
Review Contractor (RC) | |||
Empower AI, Inc. | 8701 Park Central Drive, | (800) 393-3068 | |
Eligibility Review Contractor (ERC) | |||
Booz Allen Hamilton | 20 M Street SE | (202) 203-3700 | |
State PERM Leads from DHS
Christine Kline, PERM Project Coordinator/Liaison | (717) 705-6851 | |
Cathy Martin, Medicaid-Claims Primary | (717) 705-8390 | |
Brendan Malloy, Medicaid Eligibility | (412) 565-2779 | |
Virginia Perry, CHIP | (717) 772-1110 |
Additional Provider Information
- CMS PERM Website: www.cms.gov/PERM
The "providers" page helps to better understand the PERM process and what you may be required to do during a review.