Nebraska Medicaid Program

Current Initiatives

Payment Error Rate Measurement (PERM)

The Centers for Medicare and Medicaid Services (CMS) is conducting the Payment Error Rate Measurement (PERM) program to assess the occurrence of improper payments in Medicaid in accordance with the Improper Payments Information Act (IPIA) of 2002. As a part of this program, medical records of sampled claims will be reviewed to ensure that all paid claims were medically necessary. Nebraska Medicaid staff will be working with the contractor to ensure all requested documentation from providers has been received in order to avoid errors..

We recognize providers are concerned with maintaining the privacy of patient information. However, the collection and review of protected health information contained in individual-level medical records for payment review purposes is allowed by the Health Insurance Portability and Accountability Act (HIPAA) and implementing regulations at 45 Code of Federal Regulations, parts 160 and 164. This permits the collection and review of protected health information to meet the CMS PERM requirements.

The claims that have been selected are from all claims that were paid by Nebraska Medicaid from October 1, 2006 through September 30, 2007. Of all the claims that were paid during that time, approximately 2,000 were selected for review. This means that some of our higher volume providers may have more than one service selected to send medical documentation in on. It also means that there are some providers who will not have any claims selected at all. The sampled claims were selected by a federal contractor with no ties to the Nebraska Medicaid program.

All providers who have submitted claims that have been sampled by CMS will be receiving a letter from Livanta LLC. This letter will be on CMS letterhead. The letter will request medical records for a particular service that was performed by the provider. The provider will be given 60 calendar days to submit the requested documentation before the claim will be found to have been paid in error. The letter requesting records will have a date at the top identifying when records must be submitted. You will also receive two follow-up notices if records have not yet been received by Livanta. The first will be 15 days after the original request, and the second will be 35 days after the original request. If records are not submitted and the claim is found to have been paid in error, Nebraska Medicaid may request a refund from that provider for that service.

If you have any questions about the review process, or if you want to verify that a request for records that you have received is genuine, please contact Betsie Steenson at 402-471-9353 or by email at betsie.steenson@dhhs.ne.gov.