PERM

The Centers for Medicare & Medicaid Services (CMS), in partnership with the States, is measuring improper payments in the Medicaid and Children’s Health Insurance Program (CHIP) programs under their Payment Error Rate Measurement (PERM) process.

CMS and its PERM contractor, Empower AI, have begun sending medical records requests effective June 6, 2024. These requests will be sent directly to Missouri Medicaid/CHIP providers for claims billed during state fiscal year 2024. Empower AI will also be contacting providers directly to obtain contact information to ensure that the medical records request is sent to the correct contact/location. Please be sure to comply with any contact information requests and medical record requests. Additional information about the PERM program is addressed on the CMS PERM website (https://www.cms.gov/PERM). Refer to the “Providers” link on the website.

Federal regulations require that Medicaid/CHIP providers submit the medical record documentation to support claims for Medicaid/CHIP services to CMS upon request. Providing medical records for Medicaid/CHIP patients does not violate the Health Insurance Portability and Accountability Act (HIPAA). Patient authorization is not required to respond to this request. CMS and its contractors will comply with the Privacy Act federal regulations governing the sharing and transmission of Protected Health Information (PHI).

Questions regarding the PERM audit may also be directed to the State PERM representative Joyce Chandler at 573-751-7993 or please email MMAC.PERMAUDITS@DSS.MO.GOV.