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Provider Notice issued 11/08/2023
| Date: | November 8, 2023 |
| To: | All Medical Assistance Program Providers |
| Re: | Payment Error Rate Measurement (PERM) Audit Compliance |
This notice advises providers that Illinois’ Rate Year (RY)25 Payment Error Rate Measurement (PERM) audit is beginning soon. To comply with the Improper Payments Information Act of 2002, the federal Department of Health and Human Services, Center for Medicare & Medicaid Services (federal CMS) conducts the PERM program, which measures improper payments within each state's Medicaid and Children's Health Insurance Program (CHIP) program. Each state is required to participate in PERM every three (3) years.
CMS will be conducting this audit through their contractor, Empower AI. Providers may be contacted by Empower AI with a request to provide records to support the payment review of randomly sampled claims. The RY25 cycle will sample claims paid on/between July 1, 2023, through June 30, 2024.
Notifications and record requests from Empower AI for this PERM audit are legitimate. Provider cooperation with the PERM audit is required (see Chapter 100, Handbook for Providers of Medical Services, Topic 110.3, Availability of Records).
Failure to comply with the audit will result in audit findings and the recovery of subsequent overpayments. Audit findings may also result in sanctions or other penalties, including but not limited to: (1) termination or suspension of the provider's eligibility to participate as a Medicaid and/or CHIP provider; (2) suspension or denial of the provider's payments; and (3) civil monetary penalties.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs