Attention All Providers: Payment Error Rate Measurement (PERM) Audit Update

Aug 29, 2022

The State of Maine has completed the process of a federally mandated Payment Error Rate Measurement (PERM) audit for Reporting Year 2021. (See e-message sent 02/06/2020.) This audit covered randomly selected paid claims with payments dated July 1, 2019, through June 30, 2020.  

Claims Submission 

It is a MaineCare provider’s responsibility to make sure that all claims sent to MaineCare are true and accurate. For each claim submitted, you must be sure to include the correct member’s name, member status, date of service, bill type, billed units and charges, and procedure codes. Claims should also include modifiers, medical assessments, daily shift notes, physician’s orders, home support provider census sheets, pre-authorizations, Resource Utilization Groups (RUGS), admission dates, Attending National Provider Identifier (NPI), etc., as applicable.  

Maintaining Records 

MaineCare Benefits Manual Chapter I, Section 1.03 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.” 

The following list represents the most common miscellaneous errors found in our last two PERM cycles. A previous message was sent including billing and documentation errors. Please review this document for the full list of the most common errors.

 

Miscellaneous Errors may be related to the information on the claim that the provider submitted to MaineCare or to the information that the provider submitted during the PERM audit.

• The provider did not respond to the request for records. If a provider does not respond to the request for records during the PERM audit it is automatically considered a payment error, so please respond timely.
• The provider did not have the beneficiary on file or in the system. It is the provider’s responsibility to maintain accurate records for each member and for each service provided to that member.
• The State could not locate the provider. If a provider has ceased operations, the provider must notify MaineCare that operations have ceased and must maintain records in accordance with MaineCare Benefits Manual - Chapter 1, Section 1.03.
• The provider moved and did not notify MaineCare of the change. If a provider is moving locations, the provider must notify MaineCare in accordance with MaineCare Benefits Manual - Chapter 1, Section 1.03.

 

For questions, please contact Kealoha Rosso by phone at (207) 624-6929 or by email. Please DO NOT send medical records to this contact. Thank you.