Payment Error Rate Measurement (PERM) Audit

Nov 13, 2023

Empower AI is currently requesting medical records from providers. Please be advised that this is a legitimate request and is part of the federally mandated PERM audit.  

Current PERM Audit 

The State of Maine is currently in the process of a federally mandated PERM audit for Reporting Year (RY) 2024. This audit covers randomly selected paid claims with a payment date from July 1, 2022 through June 30, 2023. If a provider’s claims have been selected for the audit, they will receive a request for medical records from Empower AI, who has contracted with the Centers for Medicare & Medicaid Services (CMS) to conduct the audit. Because the claim samples are chosen randomly, all providers should be prepared to send requested medical records to support claims that were paid during this time period. 

Required Medical Records 

In the coming weeks and months, you may receive a request for medical records for a specific claim from Empower AI.  Empower AI may first contact a provider by telephone to get the correct contact information, after which they will send their request for medical records. The letter request for medical records will list the name of the contracted agency conducting the PERM audit.

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. Please see MaineCare Benefits Manual - Chapter 1, Section 1.03 for more information about this requirement.  

Financial Impact of Errors and Lack of Documentation 

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. 

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. 

PERM Webpage 

Go to the State of Maine PERM webpage for more information about federal requirements, common errors found in previous cycles, Frequently Asked Questions (FAQs), and Record Request Guidelines. 

Contact Information 

• For questions about medical records requests, including questions on the terminology used in some of the communications from Empower AI, please contact the Empower AI Medical Records Manager. The contact information is printed on the bottom of the documentation request letter that you received.  
• You can email CMS with general questions on the federal PERM program and provider specific questions at PERMProviders@cms.hhs.gov. Please DO NOT send medical records to this contact.  
• Please contact Kealoha Rosso by phone at (207) 624-6929 or email  kealoha.e.rosso@maine.gov for State of Maine-specific questions. Please DO NOT send medical records to this contact.