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<title>Attention All Providers: Payment Error Rate Measurement (PERM) Audit</title>
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<p class="MsoNormal">Dear Champions of Education,<o:p></o:p></p>
<p class="MsoNormal">FYI, MaineCare Payment Error Rate Measurement (PERM) Audit<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p>The State of Maine is currently in the process of a federally mandated PERM audit for Reporting Year 2024.
<span style="background:yellow;mso-highlight:yellow">This audit covers randomly selected paid claims with a payment date from July 1, 2022, through June 30, 2023.</span> Due to the random sampling of claims,<b><span style="color:red"> all providers</span></b> should
be prepared to send requested medical records to support claims that were or will be paid during this time period. More details below.<o:p></o:p></p>
<p>Thank you for your dedication and commitment to educating Maine’s most vulnerable youth!<o:p></o:p></p>
<p>Mary<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
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<div style="border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in">
<p class="MsoNormal"><b>From:</b> Office of MaineCare Services <meoms@subscriptions.maine.gov>
<br>
<b>Sent:</b> Wednesday, July 19, 2023 9:01 AM<br>
<b>To:</b> Adley, Mary <Mary.Adley@maine.gov><br>
<b>Subject:</b> Attention All Providers: Payment Error Rate Measurement (PERM) Audit<o:p></o:p></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><b><span lang="EN" style="color:crimson">EXTERNAL: This email originated from outside of the State of Maine Mail System. Do not click links or open attachments unless you recognize
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<p class="MsoNormal"><span style="mso-bookmark:gd_top"></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDMsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHA6Ly93d3cubWFpbmUuZ292L2RoaHMvP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyMzA3MTkuNzk4Njc1NTEifQ.qBkOM6iIoIhNWgE_LKzZpsZzNaT-brdxyJ1oHQurEEk/s/1191514404/br/222860245709-l"><span style="mso-bookmark:gd_top"><b><span style="font-size:13.0pt">Attention
All Providers: Payment Error Rate Measurement (PERM) Audit</span></b></span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"><b><span style="font-size:13.0pt"><o:p></o:p></span></b></span></p>
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<p class="MsoNormal"><span style="mso-bookmark:gd_top"></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDQsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHA6Ly93d3cubWFpbmUuZ292L2RoaHMvb21zL3Byb3ZpZGVycy9wcm92aWRlci1idWxsZXRpbnMvYXR0ZW50aW9uLWFsbC1wcm92aWRlcnMtcGF5bWVudC1lcnJvci1yYXRlLW1lYXN1cmVtZW50LXBlcm0tYXVkaXQtMjAyMy0wNy0xOT91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjMwNzE5Ljc5ODY3NTUxIn0.C99xXw6C3-Wxp5c4MxVJcuRHa-Q1ndWbwdxhtju4Uv8/s/1191514404/br/222860245709-l"><span style="mso-bookmark:gd_top">Attention
All Providers: Payment Error Rate Measurement (PERM) Audit </span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"><o:p></o:p></span></p>
<div>
<p class="MsoNormal"><span style="mso-bookmark:gd_top">Jul 19, 2023<o:p></o:p></span></p>
</div>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Current PERM Audit </span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">The State of Maine is currently in the process of a federally mandated PERM audit for Reporting Year 2024. This audit covers randomly selected paid claims with a payment date from July 1, 2022, through June 30, 2023. Due
to the random sampling of claims, all providers should be prepared to send requested medical records to support claims that were or will be paid during this time period. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">PERM Description and Federal Requirements </span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">PERM measures improper payments in Medicaid and the State Children’s Health Insurance Program (CHIP) and produces state- and national-level error rates for each program as required by the Improper Payments Information Act
(IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Improvement Act or IPERA, and the Improper Payments Elimination and Recovery Improvement Act of 2012 or IPERIA). See the </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDUsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvUmVzZWFyY2gtU3RhdGlzdGljcy1EYXRhLWFuZC1TeXN0ZW1zL01vbml0b3JpbmctUHJvZ3JhbXMvTWVkaWNhaWQtYW5kLUNISVAtQ29tcGxpYW5jZS9QRVJNL2xhd3NhbmRyZWd1bGF0aW9ucz91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjMwNzE5Ljc5ODY3NTUxIn0.PNjNMQARECcn6iuV4JdwDqwhc-R2_KDSCJBPod7hFbg/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">CMS
PERM Laws and Regulations webpage</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> for more details. CMS also has a </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDYsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvUmVzZWFyY2gtU3RhdGlzdGljcy1EYXRhLWFuZC1TeXN0ZW1zL01vbml0b3JpbmctUHJvZ3JhbXMvTWVkaWNhaWQtYW5kLUNISVAtQ29tcGxpYW5jZS9QRVJNL1Byb3ZpZGVycz91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjMwNzE5Ljc5ODY3NTUxIn0.Zk2McH-6oVfyEUB9c3vag857Am0BObS-FmJFEWdMN70/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">dedicated
page for providers</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top">, complete with a link to Frequently Asked Questions (FAQs). <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Required Medical Records</span></strong> <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Beginning this week, you may receive a request for medical records for a specific claim from Empower AI. Please be advised that this is a legitimate request and is part
of the federally mandated PERM audit. </span></strong>Empower AI has contracted with the Centers for Medicare and Medicaid Services (CMS) to conduct the audit of MaineCare claims. Per MaineCare policy, providers who are contacted by Empower AI for the purpose
of the PERM audit are required to respond to their requests for information and provide the necessary documentation so they can conduct their reviews. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">Please see the </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDcsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LmNtcy5nb3YvUmVzZWFyY2gtU3RhdGlzdGljcy1EYXRhLWFuZC1TeXN0ZW1zL01vbml0b3JpbmctUHJvZ3JhbXMvTWVkaWNhaWQtYW5kLUNISVAtQ29tcGxpYW5jZS9QRVJNL0Rvd25sb2Fkcy8yMDE2SW5pdGlhbFJlcXVlc3Rmb3JSZWNvcmRzTGV0dGVyLnBkZj91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjMwNzE5Ljc5ODY3NTUxIn0.tpGiKcos6TF3S2qEkxebshfKSred-lA_sDCJOPX3-Rs/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">sample
request letter</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> for more information. The letter request for medical records will list the name of the contracted agency conducting the PERM audit. Please note, the PERM auditor
is Empower AI, not CNI Advantage as noted on the sample letter. Please see </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDgsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHA6Ly93d3cubWFpbmUuZ292L3Nvcy9jZWMvcnVsZXMvMTAvMTQ0L2NoMTAxL2MxczAwMS5kb2N4P3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSIsImJ1bGxldGluX2lkIjoiMjAyMzA3MTkuNzk4Njc1NTEifQ.-rbP_f9m6bdcnHItYhJSl-8Yap6GrLBVJ43NtVNrsHY/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">MaineCare
Benefits Manual - Chapter 1, Section 1.03</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> for more information about this requirement. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Financial Impact of Errors and Lack of Documentation </span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">It is critical that providers respond to requests for documentation in a timely fashion. Records that are incomplete, submitted late, or not submitted at all will result in an automatic error and will be considered an improper
payment. The State will have to reimburse the federal government for all improper payments and may seek reimbursement from providers who did not comply with federal law. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Failure for a provider to return the requested documentation in the proper format within the requested timeframe could result in recoupment of MaineCare payment on that
claim. </span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">The most common errors found in our previous two PERM cycles can be found
</span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMDksInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lm1haW5lLmdvdi9kaGhzL3NpdGVzL21haW5lLmdvdi5kaGhzL2ZpbGVzL2lubGluZS1maWxlcy9SWTIwMjElMjBSdW5uaW5nJTIwbGlzdCUyMG9mJTIwUEVSTSUyMEVycm9ycy5wZGY_dXRtX21lZGl1bT1lbWFpbCZ1dG1fc291cmNlPWdvdmRlbGl2ZXJ5IiwiYnVsbGV0aW5faWQiOiIyMDIzMDcxOS43OTg2NzU1MSJ9.2ZnlMbzyVD6e8GbAbhNEeUMMEfIGmACe67leiKvGr7Y/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">here</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top">. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Resources for the Documentation Records Audit</span></strong> <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">CMS has produced a video titled </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTAsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3LnlvdXR1YmUuY29tL3dhdGNoP3V0bV9tZWRpdW09ZW1haWwmdXRtX3NvdXJjZT1nb3ZkZWxpdmVyeSZ2PVZ0M1VBZExBQlVZIiwiYnVsbGV0aW5faWQiOiIyMDIzMDcxOS43OTg2NzU1MSJ9.wPqB9rAid540oA7p8zvgiYkqroeYEpRNKjl8Tipw4Es/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">“PERM:
Responding to Medical Records/Documentation Requests”</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> that providers may find useful in preparing their records for audit. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Provider Billing Reminders </span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">As a MaineCare provider, it is your responsibility to make sure that all claims sent to MaineCare are true and accurate. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"></span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTEsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lm1haW5lLmdvdi9zb3MvY2VjL3J1bGVzLzEwLzE0NC9jaDEwMS9jMXMwMDEuZG9jeD91dG1fbWVkaXVtPWVtYWlsJnV0bV9zb3VyY2U9Z292ZGVsaXZlcnkiLCJidWxsZXRpbl9pZCI6IjIwMjMwNzE5Ljc5ODY3NTUxIn0.49t5BtMUFuTXnGqAqIlAe-4KJrGUVP1yZFSafhofwOw/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">The
MaineCare Benefits Manual, Chapter 1, Section 1.03</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> states that all providers must “Maintain and retain contemporaneous financial, provider, and professional records sufficient
to fully and accurately document the nature, scope and details of the health care and/or related services or products provided to each individual MaineCare member” and that these records are kept “for a period of not less than five (5) years from the date
of service or longer if necessary to meet other statutory requirements. If an audit is initiated within the required retention period, the records must be retained until the audit is completed and a settlement has been made.” <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Maine PERM Webpage </span></strong><o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top">Go to the </span><a href="https://lnks.gd/l/eyJhbGciOiJIUzI1NiJ9.eyJidWxsZXRpbl9saW5rX2lkIjoxMTIsInVyaSI6ImJwMjpjbGljayIsInVybCI6Imh0dHBzOi8vd3d3Lm1haW5lLmdvdi9kaGhzL29tcy9hYm91dC11cy9wcm9qZWN0cy1pbml0aWF0aXZlcy9wYXltZW50LWVycm9yLXJhdGUtbWVhc3VyZW1lbnQ_dXRtX21lZGl1bT1lbWFpbCZ1dG1fc291cmNlPWdvdmRlbGl2ZXJ5IiwiYnVsbGV0aW5faWQiOiIyMDIzMDcxOS43OTg2NzU1MSJ9.u42DW0l8s9EqL-bPDuk7OkCtqUXa-KSxANZIFyvOxKY/s/1191514404/br/222860245709-l" target="_blank"><span style="mso-bookmark:gd_top">Maine
PERM Audit webpage</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> for more information about federal requirements, common errors found in previous cycles, Frequently Asked Questions (FAQs), and Record Request Guidelines. <o:p></o:p></span></p>
<p><span style="mso-bookmark:gd_top"><strong><span style="font-family:"Calibri",sans-serif">Contact Us</span></strong> <o:p></o:p></span></p>
<ul type="disc">
<li style="mso-list:l0 level1 lfo1"><span style="mso-bookmark:gd_top">Questions about medical record requests, including questions on the terminology used in some of the communications from Empower AI - Contact the Empower AI Medical Records Manager. The contact
information is printed on the bottom of the documentation request letter you receive. <o:p></o:p></span></li></ul>
<ul type="disc">
<li style="mso-list:l1 level1 lfo2"><span style="mso-bookmark:gd_top">General questions on the federal PERM program and provider specific questions - Email CMS at </span><a href="mailto:PERMProviders@cms.hhs.gov" target="_blank"><span style="mso-bookmark:gd_top">PERMProviders@cms.hhs.gov</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top">. Please
<strong><span style="font-family:"Calibri",sans-serif">DO NOT</span></strong> send medical records to this contact. <o:p></o:p></span></li><li style="mso-list:l1 level1 lfo2"><span style="mso-bookmark:gd_top">State of Maine-specific questions - Contact Kealoha Rosso, phone (207) 624-6929, email: </span><a href="mailto:kealoha.e.rosso@maine.gov" target="_blank"><span style="mso-bookmark:gd_top">kealoha.e.rosso@maine.gov</span><span style="mso-bookmark:gd_top"></span></a><span style="mso-bookmark:gd_top"> Please
<strong><span style="font-family:"Calibri",sans-serif">DO NOT</span></strong> send medical records to this contact. <o:p></o:p></span></li></ul>
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