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ND Medicaid Program Integrity

Payment Error Rate Measurement (PERM)

The Payment Error Rate Measurement (PERM) review is a federal requirement and North Dakota is on a rotation cycle to be reviewed once every three (3) years.

North Dakota is currently in the PERM Review Year 2019 for Medicaid and the Children's Health Insurance Program (CHIP) claims payment and eligibility determination. The PERM review period has been adjusted from a federal fiscal year to review payments made from July through June to align with the state fiscal year and to provide additional time to complete the cycle before reporting payment rates.

This cycle will review Medicaid and CHIP payments made in Reporting Year (RY) 2019 (July 1, 2017 through June 30, 2018).

Providers will receive medical records requests from the Review Contractor (RC), Chickasaw Nation Industries (CNI). (A sample copy of the Envelope, Initial Request for Records Letter and the Claim Category Letter Packet is attached below). Please make sure that your Release of Information departments are aware and responding to the records requests in a timely manner.

Providers should start receiving the letters sometime in late July or August 2018.

  • A period of 75 days are given to submit the requested documentation.
  • CNI makes reminder calls and sends reminder letters on day 30, 45, and 60 until the medical records are received.
  • If the provider does not respond, CNI sends a nonresponse letter on day 75 to the State PERM Representative.
  • If submitted documentation is incomplete, CNI requests additional documentation.
  • The provider will then have 14 days to submit additional documentation.
  • CNI makes a reminder call and sends a letter on day 7.
  • If the provider does not respond, CNI sends a nonresponse letter after 14 days to the State PERM Representative.
  • Failure to submit documentation, or if the submitted documentation is incomplete, the claim(s) will be considered an error and subject to recoupment.

PERM Claim Category Matrix – This document lists all PERM claim categories and medical records requested from providers for claim categories 1 through 17.

Medical Record Request Envelope – This is the envelope used when the letter packet is mailed.

Medical Record Request Letter – This is the Initial Request for Records Letter template.

Medical Record Request Letter Packet – This is the template of a Claim Category 1 Letter Packet (each provider receives a letter packet for their claim category).

Last page of each letter packet is the provider instructions for record submissions to the RC.

When submitting records, we highly recommend the use of the corresponding Medical Review (MR) cover sheet with each submission for quick and accurate processing of record submissions. The MR cover sheet is included with your PERM letter.

General PERM information (Centers for Medicare and Medicaid Services):
http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/index.html

Questions may be directed to:

Jeanne Folmer, CFE, CPC, CHA
Medicaid Program Integrity Audit Coordinator
ND Department of Human Services, Medical Services Division
600 E. Boulevard Ave., Dept. 325
Bismarck, ND 58505-0250
Phone: (701) 328-4831
Email: jfolmer@nd.gov

 

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