Crosswalk for summary findings final

Revisions to Form CMS# 10184 (0938-1012) Payment Error Rate Measurement-State Medicaid and CHIP Eligibility
Payment Error Rate Measurement (PERM)

Issue
#
1.

2.

Form

Section

Payment Error
Rate
Measurement
(PERM) – State
Medicaid and
CHIP Eligibility
CMS – 10184E

Action to be
performed
Electronic system
has changed from
PERT to PETT
Revise as follows

Changes to the Form

Reason for the Change

Change in contractor, therefore the
electronic system used to capture data
has changed
Replace with: Payment Error Rate Revised to reduce burden on the state
Measurement (PERM)
to use one collection instrument to
Eligibility Review Findings
capture required information
Form

A.

3.
4.

State

Revise as follows

B. State

5.

Date

Change to

C.

Date

6.

Program

Change to

D.

Program

7.

Total

Moved

Move to Row 12 Replace with
Totals

Revised for clarification purpose
A letter added for ease in identifying
specific fields
Revised for clarification purpose
A letter added for ease in identifying
specific fields
Revised for clarification purpose
A letter added for ease in identifying
specific fields
Revised for clarification purpose

1

Issue
#
8.

9.

Revisions to Form CMS# 10184 (0938-1012) Payment Error Rate Measurement-State Medicaid and CHIP Eligibility
Payment Error Rate Measurement (PERM)
Form
Section
Action to be
Changes to the Form
Reason for the Change
performed
Active
Change to
E. Active
Revised for clarification purpose
Stratum 1
Stratum 1
A letter added for ease in identifying
Stratum 2
Stratum 2
specific fields
Stratum 3
Stratum 3

Negative
Denials
Terminations

Change to

E. Negatives
Denials
Terminations

Revised for clarification purpose
A letter added for ease in identifying
specific fields

Add column

Label column 1 : Number of Cases
in Universe

Revised for clarification purpose

Number of Cases
Excluded from the
Sample due to
Fraud
Number of Cases
Eligible

Change to

Replace with Number of Cases
Dropped from Sample

Revised for clarification purpose

Change to

Replace with Number of Cases
Correct

Revised for clarification purpose

13.

Number of Cases
Ineligible

Change to

Replace with Number of Cases
Incorrect

Revised for clarification purpose.

14.
15.

Total Dollars Paid

Change to
Add Column #10

Replace with Total Dollars Correct
Label column: Total Dollars
Undetermined

10.
11.

12.

Review Month
16.

Active Payment
Error Rate

Removed

17.

Active Case Error
Rate

Removed

18.

Negative Case
Error Rate

Removed

19.

Undetermined

Removed

Revised for clarification purpose
Revised for clarification purpose.

Revised due to a change in guidance.
Calculations done by the Federal
statistical contractor
Revised due to a change in guidance.
Calculations done by the Federal
statistical contractor
Revised due to a change in guidance.
Calculations done by the Federal
statistical contractor
Revised due to a change in guidance.
2

Issue
#

Revisions to Form CMS# 10184 (0938-1012) Payment Error Rate Measurement-State Medicaid and CHIP Eligibility
Payment Error Rate Measurement (PERM)
Form
Section
Action to be
Changes to the Form
Reason for the Change
performed
Cases and
Calculations done by the Federal
Percentage
statistical contractor

3