Gainwell delivered a communication this week to notify pharmacies that the 2025 Payment Error Rate Measurement (PERM) program is now in progress. The Department of Medicaid (ODM) is mandated to participate in PERM by the Centers for Medicare and Medicaid (CMS). The program will assess payment accuracy rate for the Medicaid and CHIP programs. If chosen in a random sample, your pharmacy will soon receive a Medical Records Request from the CMS review contractor, Empower AI. This cycle measurement will review Medicaid and CHIP payments made in Reporting Year (RY) 2025: July 1, 2023, through June 30, 2024. ODM may recover payments made to providers who fail to cooperate by the established deadlines. Providers must retain recipient records for six years from the date of payment, under the terms of the Provider Agreement, even if they no longer do business with ODM. For more information about PERM, please visit the Provider link on the CMS PERM website. A video explaining the process is also available. For questions, please contact the ODM Medicaid Audit Coordination Team.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.