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pdfCMS PERM—PETT 2.0 Web Application Project
User Guide Documentation
May 13, 2012
CMS PERM—PETT 2.0 Web Application Project
Table of Contents
Table of Contents
1.0 Introduction ................................................................................................................................ 1
2.0 User Registration and Login ......................................................................................................... 1
2.1 Login Screen ................................................................................................................................. 1
2.2 Registration ................................................................................................................................... 2
2.3 Password Retrieval Feature ......................................................................................................... 3
3.0 General System Areas and Features ............................................................................................ 4
3.1
3.2
3.3
3.4
3.5
System Navigation and Getting Around........................................................................................ 4
Main Dashboard............................................................................................................................ 5
Manage My Account ..................................................................................................................... 6
Help ............................................................................................................................................... 6
Contact .......................................................................................................................................... 7
4.0 Data Submission .......................................................................................................................... 8
4.1
4.2
4.3
4.4
4.5
4.6
Types of Data to be Submitted ..................................................................................................... 8
Data Submission Timeline ............................................................................................................ 9
Input Data Online .......................................................................................................................... 9
Upload Data via Spreadsheet ..................................................................................................... 12
Data Submission Errors .............................................................................................................. 14
Viewing and Editing Data ............................................................................................................ 15
5.0 View Reports ............................................................................................................................. 16
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8
PERM Calculator ........................................................................................................................ 16
Eligibility Report .......................................................................................................................... 17
Summary Report ......................................................................................................................... 18
Submission Change Report ........................................................................................................ 19
Payment Weight Report .............................................................................................................. 20
Error Rate Report........................................................................................................................ 21
Case Review Detail Report......................................................................................................... 22
PETT Data Exports ..................................................................................................................... 23
6.0 State Profile .............................................................................................................................. 23
6.1 View State Details ....................................................................................................................... 23
Appendix A: PERM Eligibility Form ..................................................................................................... 24
Appendix B: PERM Eligibility Review Findings Form Line by Line Instructions ..................................... 25
Appendix C: PERM Eligibility Summary Case Review Findings Form .................................................... 33
Appendix D: PERM Eligibility Summary Case Review Findings Form Line by Line Instructions ............. 34
Appendix E: PERM Eligibility Medicaid and CHIP Timeline .................................................................. 37
Table of Contents
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Figures
Figures
Figure 1: Login Screen ................................................................................................................. 2
Figure 2: Registration Page ......................................................................................................... 2
Figure 3: New Password Dialog Box ........................................................................................... 4
Figure 4: Home Screen Featuring Main Dashboard .................................................................... 4
Figure 5: Main Dashboard ........................................................................................................... 5
Figure 6: Manage My Account Screen ......................................................................................... 6
Figure 7: Help Screen .................................................................................................................. 7
Figure 8: Contact Screen ............................................................................................................. 7
Figure 9: Online Data Submission Form Universe Screen ........................................................ 10
Figure 10: Online Data Submission Form Case Entry Screen ................................................... 11
Figure 11: Online Submission Of Eligibility Review Data ........................................................... 12
Figure 12: Online Submission Of Payment Review Data .......................................................... 12
Figure 13: Spreadsheet Upload Screen ..................................................................................... 13
Figure 14: Spreadsheet Upload Process ................................................................................... 14
Figure 15: Error Notification During Data Submission ............................................................... 15
Figure 16: View Data Screen ..................................................................................................... 16
Figure 17: PERM Calculator Report .......................................................................................... 17
Figure 18: Eligibility Report ........................................................................................................ 18
Figure 19: Summary Report ....................................................................................................... 19
Figure 20: Submission Change Report ...................................................................................... 20
Figure 21: Payment Weight Report ............................................................................................ 21
Figure 22: Error Rate Report ..................................................................................................... 22
Figure 23: Case Review Findings Report .................................................................................. 22
Figure 24: PETT Data Exports ................................................................................................... 23
Figure 25: State Profile .............................................................................................................. 23
Figure 26: Appendix A Excel Spreadsheet ................................................................................ 24
Figures
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Introduction
1.0 Introduction
Each state participating in the Payment Error Rate Measurement (PERM) program is required to
conduct Medicaid and CHIP eligibility reviews and to submit sample, eligibility review and
payment review data on a monthly basis. To facilitate this process, CMS worked with VMD
Systems and The Lewin Group to develop the new PERM Eligibility Tracking Tool (PETT 2.0), a
secure, web-based system that allows states to submit, manage, track, and view reports of their
data online.
PETT 2.0 facilitates the data submission process and allows states to examine eligibility review
findings and error rates throughout the PERM eligibility cycle. It now provides the following new
features:
► A centralized dashboard to track the submission of time-sensitive state data
► The ability to upload data using an excel spreadsheet or submit data directly to the
website as well as edit data directly on the website
► Access to several exportable and printable data reports that enhance user
understanding of submitted data and findings
The PETT 2.0 website is accessible to authorized system and program administrators
(e.g., CMS, Lewin, and VMD), state administrators, and state viewers who monitor data
submission or provide input to the PERM program. Users will have different website privileges
depending on their program roles. During the registration process, state users will be asked to
select which level of access they are requesting – state administrator or state viewer. Users will
be approved by CMS and Lewin after the state eligibility lead notifies CMS and Lewin regarding
which individuals should have access to the website.
The remaining sections of this document describe how to access and use the PETT 2.0
website.
2.0 User Registration and Login
2.1
Login Screen
To access this feature: Go to the PETT 2.0 website which can be accessed at the
following web address: https://www.cmspett2.org.
The login screen is the first screen that users will see when they go to the PETT 2.0
website. New users will need to register. If you have already registered, enter your casesensitive user name and password and click the “Login” button.
If a user is inactive for 15 minutes, the user will have to login again to continue working.
The user will be returned automatically to the web section they had been working on.
Login Screen
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User Registration and Login
Figure 1: Login Screen
2.2
Registration
To access this feature: Click the “Register here” link on the login screen.
Figure 2: Registration Page
Registration
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CMS PERM—PETT 2.0 Web Application Project
User Registration and Login
New users must register for access to the PETT 2.0 website. Each state will be allowed
to have up to four users. Each state user will be designated as either a state
administrator or a state viewer. State administrators will be able to input, edit, and review
their state’s data, while state viewers will only be able to review their state’s submitted
data.
During the registration process, state users should select the appropriate level of access
from the “System Role” drop-down box. State users should also identify their
“Project Role” (e.g., CHIP lead, reviewer, state contractor). Finally, the state PERM
eligibility lead has the option of selecting the box under “My Status” to indicate their role
as the State Lead. The State Lead informs CMS and Lewin who in their state should
have access as a state administrator or state viewer.
Users also need to identify themselves as working with Medicaid, CHIP, or both
programs by selecting the appropriate boxes under “My Program(s).” Users will only be
able to see data for the specific program(s) for which they are registered.
New users will need to create a case-sensitive user name and password. Passwords
must be at least eight characters long and contain at least one of each of the following:
►
►
►
►
A number
An upper case letter
A lower case letter
A special character !#$%&()*+,-./:;<=>?@[\]^_{|}~
Users will need to change their passwords every 60 days; after changing the password,
the user will need to login again.
All new account registrations are sent to system administrators (CMS and Lewin) for
review. If they approve the new user, the system administrator will enable the account
and send the new user a “User Account Approved” email with login instructions.
Confirmation emails will be sent from [email protected] typically within 48
hours of registration. To ensure that emails are received, users should add
[email protected] to their contact list and follow up with CMS and Lewin if
confirmation is not received within 48 hours.
2.3
Password Retrieval Feature
To access this feature: Click the “Forgot your password?” link on the login screen.
Users should enter their user name. A new password will be sent to the email address
associated with the user name. Users can only reset their password once per day.
Forgotten user names can only be retrieved by contacting the system administrators,
which can be accomplished using the contact form (described in Section 3.4).
Password Retrieval Feature
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General System Areas and Features
Figure 3: New Password Dialog Box
3.0 General System Areas and Features
3.1
System Navigation and Getting Around
Once users login to the PETT 2.0 website, they will see the home screen. The home
screen features the main dashboard and links to other pages of the website.
Users can access the data management features of the PETT 2.0 system via the tabbased navigation area. Users can hover over each tab to view the sub-menu. In
Figure 4, the sub-menu for View Reports is displayed.
Users can also access account management and support features via the bar in the
upper right corner. These navigation tools appear on the home screen and every page of
the website.
Figure 4: Home Screen Featuring Main Dashboard
System Navigation and Getting Around
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3.2
General System Areas and Features
Main Dashboard
To access this feature: After logging in to the website, users will be taken directly to
the Main Dashboard which is located on the PETT 2.0 website’s homepage. If you
navigate away from this screen, you can return by clicking the “Main Dashboard” tab.
The Main Dashboard displays a summary of the data submission status of the user’s
state for the selected fiscal year. Users can select the fiscal year they’d like to view
using the “Select Year” drop-down menu on the right side of the screen. Users will only
see information about the programs for which they are registered. For instance, if a user
is associated with a stand-alone CHIP program, the dashboard will display only the
state’s CHIP program (which will include information on the Medicaid expansion
component as well, if applicable).
The top line of the Main Dashboard is the state summary line and shows the percentage
of cases for which complete data has been submitted for each type of data submission
(i.e., sample, eligibility review, and payment review). Also shown is the date and user
who last updated the state’s data. Below the state summary line is an inset with the
status for each month. A checkmark in a green circle will be displayed for all
submissions that are complete for the given month. Data in draft form is indicated
visually by a black exclamation point in a yellow circle. Overdue data is indicated by a
white exclamation point in a red circle.
Clicking the status link for any month/submission will take the user directly to the
corresponding data submission form.
Figure 5: Main Dashboard
Main Dashboard
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3.3
General System Areas and Features
Manage My Account
To access this feature: Click the “Manage My Account” link in the upper right
navigation bar.
The Manage My Account page allows users to perform account management tasks such
as changing their password, name, and contact information.
Users cannot update their user name, system role, state, program, status as state lead,
or preference to receive notifications. To change these settings, users should contact the
system administrators using the contact form (described in section 3.4).
Figure 6: Manage My Account Screen
3.4
Help
To access this feature: Click “Help” in the upper right screen navigation bar from any
area of the system.
The Help area provides a web-based version of the guidance provided in this document.
System administrators will update this area based on feedback from users and the need
for additional program clarification.
The Help area can be accessed even if users are not logged into the PETT 2.0 system.
Manage My Account
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General System Areas and Features
Figure 7: Help Screen
3.5
Contact
To access this feature: Click the “Contact” link in the upper right navigation bar from
any area of the system.
PETT 2.0 contains a Contact feature allowing users to submit questions and comments
directly to system administrators. The system administrators will be able to assist users
with any issues users may encounter including data submission errors and PETT 2.0
website use. Users will receive a response to their messages typically within 48 hours of
submission. To ensure that they receive a response, users should add
[email protected] their contact list.
The contact form can be accessed even if users are not logged into the PETT 2.0
system.
Figure 8: Contact Screen
Contact
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Data Submission
4.0 Data Submission
As a part of the PERM eligibility review, states are required to submit sample, eligibility review,
and payment review data for each month of the PERM eligibility cycle. States have two options
to submit their data:
(1) Enter data directly onto the PETT 2.0 website
(2) Upload data to the PETT 2.0 website using an Excel spreadsheet template.
The following section describes the types of data that states must submit, the methods for data
submission, and the process for submitting data at each phase of the eligibility review
(monthly sample, eligibility review and payment review).
If a user is inactive for 15 minutes, the user will have to login again to continue working.
The user will be returned automatically to the web section they had been working on.
4.1
Types of Data to be Submitted
States are required to submit monthly sample, eligibility review, and payment review
data onto the PETT 2.0 website. The following section gives brief descriptions of each
data type.
Sample Data
Sample data details basic information about the cases that were sampled in each month
of the PERM cycle. Both active and negative cases that are sampled in a given month,
including any oversample cases, must be included in the data submission. Users must
provide the state name, the sample month, the sample year, the active universe total,
negative universe total, and the universe total for each stratum (if applicable).
Furthermore, the following information is required for each case in the sample
submission (see Appendix B for specific field definitions and requirements):
► Case or Beneficiary ID
► Universe (Active or Negative)
► Stratum (if applicable)
Note: While Eligibility Category is displayed online after Case ID, this information is not
required until the eligibility review data is submitted.
Eligibility Review Data
States must submit data on their eligibility review findings for each sampled case. The
eligibility review data provides additional detail regarding the type of case that was
sampled and whether the case was correctly granted (i.e., application or
redetermination) or denied (i.e., denial or termination) eligibility. The following
information is required for the eligibility review submission for each sampled case
(see Appendix B for specific field definitions and requirements):
Types of Data to be Submitted
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►
►
►
►
►
►
Data Submission
Eligibility Category
Case Action
Review Month
Review Finding
Cause of Error
Optional Cause of Error
Note: The “Optional Cause of Error” field only needs to be completed if the case has a
“Technical Error” review finding.
Payment Review Data
States submit payment review data for each program in each month of the sampling
timeframe. The payment review data describes the payments made either correctly or in
error as a result of a case’s eligibility review. The following information is required for the
payment review submission for each sampled case (see Appendix B for specific field
definitions and requirements):
►
►
►
►
Total Dollars
Total Dollars in Error
Total Dollars Correct
Total Dollars Undetermined
4.2
Data Submission Timeline
The three types of data described above must be submitted in order according to the
PERM review process. For each month, users must submit sample data before they can
submit eligibility review data and they must submit eligibility review data before they can
submit payment review data.
Sample data must be submitted by the 15th day of the month following the sample month
and it must be submitted before eligibility reviews begin. Upon submission, the
PETT 2.0 website will review the data to ensure the state has entered all of the required
fields and has submitted the required number of cases based on the state-specific
sample sizes calculated for the program. The user will be required to correct any errors
the PETT 2.0 website identifies. Once the sample data is approved, the state can
proceed with the eligibility reviews.
Eligibility review data is due approximately five months after the end of the sample
month. Payment review data is due approximately seven months after the end of the
sample month. The complete timeline for FY 2013 can be found in Appendix E of these
instructions. States should contact CMS and Lewin if submission delays are anticipated
with any of the required reports.
4.3
Input Data Online
To access this feature: Hover your mouse over the “Data Submission” tab and click
“Input Data Online.”
Data Submission Timeline
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Data Submission
The “Data Submission” page is used to enter, submit, and edit monthly data
submission details. The first section seen is the “Select Submission Information” box
which allows users to select the desired program (i.e., CHIP or Medicaid), month/year,
and data type (Sample, Eligibility Review, or Payment Review).
After you make the selection, you will see three sections in the online submission form:
(1) The “Select Submission Information” box
(2) The “Submission Snapshot” box shows the data submission status for the
program, month, and year selected
(3) The "Data Submission” box is used to enter data onto the PETT 2.0 website
The process for submitting data online differs slightly for each report being submitted, as
described below.
Figure 9: Online Data Submission Form Universe Screen
To submit Sample data online the user should:
(1) Select the program, month/year, and type of data (i.e., sample) that is being
submitted in the “Select Submission Information” box.
(2) Click “Go.”
(3) Enter the active universe total, negative universe total, and strata universe totals
(if applicable).
(4) Click “Start Sample” and the first case entry boxes will appear to enter sample
information (see Figure 10).
(5) Enter the Case ID, Eligibility Category (if known at time of sample submission),
Universe and Stratum (if appropriate) for the first case to be entered.
(6) Click the Over-Sample box if the case is part of the oversample.
(7) Click “Insert” and the entry will be loaded onto the PETT 2.0 website.
(8) Repeat steps 5—7 for each sampled case.
Input Data Online
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CMS PERM—PETT 2.0 Web Application Project
Data Submission
(9) Once all of the sample data has been input, click the “Submit Data” button.
Figure 10: Online Data Submission Form Case Entry Screen
To submit Eligibility Review or Payment Review data online, the user should:
(1) Enter the program, month/year, and type of data (i.e., Eligibility Review or Payment
Review) that is being submitted in the “Select Submission Information” box.
(2) Click “Go.”
(3) Click the “Add/Update” button to the right of each case.
(4) Enter the Eligibility Review information [Eligibility Category, Case Action, Review
Month, Review Finding, Cause of Error, and Optional Cause of Error (if applicable)]
or Payment Review information (Total Dollars, Total Dollars in Error, Total Dollars
Correct and Total Dollars Undetermined) for each case.
(5) Click “Save.”
(6) Repeat steps 3—5 for each sampled case. (Note: Payment review information is not
required for negative cases.)
(7) Once all of the data has been input, Click “Submit Data.”
Input Data Online
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CMS PERM—PETT 2.0 Web Application Project
Data Submission
Figure 11: Online Submission Of Eligibility Review Data
Figure 12: Online Submission Of Payment Review Data
4.4
Upload Data via Spreadsheet
To access this feature: Hover your mouse over the “Data Submission” tab and select
“Upload Data via Spreadsheet.”
The PETT 2.0 website allows states to upload data from a formatted Excel spreadsheet.
Users can download this spreadsheet from the “Upload Data via Spreadsheet” web
page. Users should not change the format of the spreadsheet to ensure the data will be
uploaded properly. After data is uploaded, users will be able to make changes directly on
the website.
Upload Data via Spreadsheet
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CMS PERM—PETT 2.0 Web Application Project
Data Submission
Figure 13: Spreadsheet Upload Screen
It is important to note that sample, eligibility review, and payment review need to be
uploaded to the PETT 2.0 website separately even though all the data for a given month
and program is included in one spreadsheet.
The following section describes this process for users.
To upload the data via spreadsheet, the user should:
(1) Select the program, month/year, and type of data (e.g., Sample) that is being
submitted in the “Select Spreadsheet to Upload” box.
(2) Click “Go”.
(3) Click the “Browse” button in the “Upload Sample File” box.
(4) Browse your computer and select the spreadsheet to be uploaded.
(5) Click the “Process Spreadsheet Data” button (will appear after selecting the
spreadsheet to be uploaded).
(6) Check the uploaded data for accuracy. If uploading sample data, click the
“Oversample” box for any case that is part of the oversample.
(7) Click the “Submit Data” button.
Upload Data via Spreadsheet
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Data Submission
Figure 14: Spreadsheet Upload Process
4.5
Data Submission Errors
The PETT 2.0 website will alert users about data errors in one of two ways.
(1) The website alerts users of an error when they initially try to insert, update, or
upload data. Users will need to correct the data before the website will accept
it. Errors may include entries that have missing required data elements and
incorrect payment review data (e.g., entry of a value other than zero in the
“Dollars in Error” field for a case with a review finding of eligible).
a. If inserting data online, users will receive an error message when they
try to insert or save the entry.
b. If uploading data via spreadsheet, users will get an error message
when the website processes the spreadsheet.
(2) The PETT 2.0 website alerts users after they try to save or submit data. Any
cases containing errors will be flagged with a red row number. Users can
click on the red row number to view an explanation of the error. They will
need to fix the error before they can submit their data. Examples of errors
include data entries with a case action that does not agree with the stratum
and missing review finding when uploading data.
Data Submission Errors
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Data Submission
Figure 15: Error Notification During Data Submission
4.6
Viewing and Editing Data
To access this feature: Hover your mouse over the “Data Submission” tab and select
“View Data.”
To view monthly data, select the desired program (CHIP or Medicaid), month/year, and
sample type (i.e., sample, eligibility review, or payment review) in the
“Select Submission Information” box and click “Go.”
After data has been successfully submitted (via online submission or through the data
upload process), users can change data by clicking the “Edit” button to the right of each
case row. The website will prompt users to provide an explanation for the change before
they save the data.
Users should not drop any case without first contacting CMS and The Lewin Group.
Once a request for a dropped case is received, CMS and The Lewin Group will review
the issue and either approve the dropped case or request additional information/action
from the state. Following this, users can drop the case on PETT 2.0 by selecting “X” as
the “Review Finding.” After selecting “X,” an administrator will have to approve the
dropped case again before it appears on the website. This double approval process
ensures that CMS and The Lewin Group are aware of all dropped cases.
Users can also click on “Print to Excel” to obtain a spreadsheet version of each month’s
entries.
Viewing and Editing Data
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View Reports
Figure 16: View Data Screen
5.0 View Reports
The following section provides information on the various data reports that are
accessible on the PETT 2.0 website. All reports can be printed by selecting the
“Print Report” in the top right corner of the screen.
5.1
PERM Calculator
To access this feature: Hover your mouse over the “View Reports” tab and click on
“PERM Calculator.”
To access the PERM Calculator report, states should select the desired fiscal year and
program, then click “Display Report”. The PERM calculator report provides states with
information on all three state error rates – active payment rate, active case rate, negative
case rate—by stratum, if applicable, as well as summary information on sample errors
and payments.
Note: The calculator report will only populate after three complete months of payment
data have been submitted to the PETT website as at least one quarter of information is
necessary to provide states with statistically relevant results.
PERM Calculator
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View Reports
Figure 17: PERM Calculator Report
5.2
Eligibility Report
To access this feature: Hover your mouse over the “View Reports” tab and click on
“Eligibility Report.”
To access the Eligibility Report, users should select the desired fiscal year and program,
then click “Display Report.” This report provides states with information on the eligibility
review findings by universe, case action or stratum, eligibility category and cause of
error. The findings are presented as percent of the total number of cases reviewed that
fall into each error type (e.g., eligible, not eligible, eligible with ineligible services, etc.).
All information is pulled directly from the data submitted by states to the website for each
sample month.
Eligibility Report
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View Reports
Figure 18: Eligibility Report
5.3
Summary Report
To access this feature: Hover your mouse over the “View Reports” tab and click on
“Summary Report.”
To access the Summary Findings report, states should select the desired fiscal year,
program, and sample month, then click “Display Report.” Note: States can see
information for the entire cycle by selecting from the Sample Month drop-down box the
option “All”.
The report is structured to meet the requirements of the Summary Review Findings table
which is due to CMS at the end of each PERM eligibility cycle. The report provides
sample summary information including universe totals, number of cases sampled and
dropped, number of cases correct, incorrect and undetermined, total dollars paid, total
dollars correct, total dollars in error, and total dollars undetermined. All information is
pulled directly from the data submitted by states to the website for each sample month.
For additional information on the required fields for the Summary Review Findings
report, please refer to Appendices C and D.
Summary Report
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View Reports
Figure 19: Summary Report
5.4
Submission Change Report
To access this feature: Hover your mouse over the “View Reports” tab and click on
“Submission Change Report.”
To access this report, states should select the desired fiscal year and program, then
click “Display Report.” Note: States can see information for the entire cycle by selecting
from the Sample Month drop-down box the option “All”.
This report details the changes made by states to previously submitted data. The report
identifies what was changed in the report for a given month and program as well as
indicates which user made the change, the date of the change, and the reason for the
change. States can download the Submission Change report in an Excel file by clicking
“Print to Excel.”
Submission Change Report
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View Reports
Figure 20: Submission Change Report
5.5
Payment Weight Report
To access this feature: Hover your mouse over the “View Reports” tab and click on
“Payment Weight Report”.
To access this report, states should select the desired fiscal year and program, then
click “Display Report.” The report provides states with information on the top ten
highest weighted case IDs (i.e., the ten cases that currently have the greatest impact on
the active case payment error rate). States can use this information to both understand
what might be driving the payment rate as well as to focus on any cases that might be
undetermined.
Payment Weight Report
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View Reports
Figure 21: Payment Weight Report
5.6
Error Rate Report
To access this feature: Hover your mouse over the “View Reports” tab and click on
“Error Rate Report.”
To access this report, states should select the desired fiscal year and program, then
click “Display Report.” The error rate report is a simplified version of the PERM
Calculator report, providing the error rates by program and stratum, if applicable.
Error Rate Report
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View Reports
Figure 22: Error Rate Report
5.7
Case Review Detail Report
To access this feature: Hover your mouse over the “View Reports” tab and click on
“Case Review Detail Report”.
To access this report, states should select the desired fiscal year and program, then
click “Display Report.” Note: States can see information for the entire cycle by selecting
from the Sample Month drop-down box the option “All”.
This report provides a detailed listing of each sampled case, the reviewing finding and
the dollars associated with the case.
Figure 23: Case Review Findings Report
Case Review Detail Report
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5.8
State Profile
PETT Data Exports
To access this feature: Hover your mouse over the “View Reports” tab and click on
“PETT Data Exports.”
To export submitted data, states should select the desired fiscal year and program,
sample month, and “Case Detail” or “Universe Totals” to be downloaded. Note: States
can export information for the entire cycle by selecting the option “All” from the Sample
Month drop-down box. Click “Export Data” then “Download Spreadsheet”. Data will be
downloaded in an Excel file format. Note: Some computers may require users to change
their security settings or allow pop-ups in order to download the Excel file. State admins
and state viewers can export data for the program(s) they are approved to access.
Figure 24: PETT Data Exports
6.0 State Profile
6.1
View State Details
To access this feature: Hover your mouse over the “State Profile” tab and click on
“View State Details.”
The State Profile shows the list of users for the selected state. Each row shows the
user’s name, email address, site login name, programs assigned, site access role, and
project role.
Figure 25: State Profile
PETT Data Exports
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Appendix A
Appendix A: PERM Eligibility Form
Figure 26: Appendix A Excel Spreadsheet
Appendix A: PERM Eligibility Form
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Appendix B
Appendix B: PERM Eligibility Review Findings Form Line by
Line Instructions
► Line A: State
The name of the State is pre-populated on the form if using the Direct Data Entry method. If
using the Upload option, select the appropriate State from the drop-down list.
► Line B: Date
The current date is pre-populated on the form if using the Direct Data Entry method. If using
the Upload option, the current date will populate after you upload the form.
► Line C: Program
The program (Medicaid or CHIP) is pre-populated on the form if using the Direct Data Entry
method. If using the Upload option, select the appropriate program from the drop-down list.
► Line D: Sample Month and Year
The sample month and year is pre-populated on the form if using the Direct Data Entry
method. If using the Upload option, select the sample month and year from the drop-down
lists.
► Line E: Active Universe Total
The Active Universe is the total number of cases in the sample month that are considered eligible
for services based on a completed application, redetermination, or are currently on the program
rolls. The universe will be unique for each month.
If the State is stratifying active cases, complete E.1, E.2, and E.3.
Enter the total number of active cases during the sample month. For active cases, include the
number of cases in each stratum in the respective cell as follows:
E.1—Stratum 1 total—Enter the total number of Stratum 1 cases during the sample
month. A case is in Stratum 1 (Applications) in the month the decision is made to grant
eligibility or in the month the eligibility becomes effective, whichever is later.
E.2—Stratum 2 total—Enter the total number of Stratum 2 cases during the sample
month. A case is in Stratum 2 (Redeterminations) in the month the decision is made to
continue eligibility or in the month the new period of eligibility becomes effective,
whichever is later.
E.3—Stratum 3 total—Enter the total number of Stratum 3 cases during the sample
month. A case is in Stratum 3 (All Other Cases) if the case is on the program in the
sample month but does not meet the Strata 1 or 2 criteria.
► Line F: Negative Universe Total
The Negative Universe is comprised of all cases denied in the sample month and all cases
where the termination is effective in the sample month. The universe will be unique for each
month.
► Case ID
Enter the case identification (ID) for each sampled case selected from both the active and
negative universes. States should use the ID that correlates with the case in the State’s
eligibility system. The State may assign a “dummy” case ID to each case to protect personally
identifiable information. If the State assigns dummy IDs, a crosswalk between the “dummy”
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Appendix B
case ID and the actual case ID should be sent on a monthly basis to CMS via secure email or
a password-protected CD.
► Eligibility Category
The eligibility category is the eligibility coverage program in which the beneficiary is enrolled
under Medicaid or CHIP. This information can be completed when you submit the Eligibility
Review Report and is not required for Negative Universe cases. For each case, select the
appropriate eligibility category from the drop-down list. The Eligibility Category options are
provided below.
If the sampled individual is enrolled in more than one category, choose what the state believes
is the "primary" category. Note that the "primary" category will not necessarily be based on
dollars associated with the case, but instead could be based on the category requested at
application.
Example: An individual is enrolled in QMB and Nursing Home Medicaid. Nursing Home is the
primary because the applicant is in need of nursing care at the time of application, and is at
that time also found eligible for QMB. In this example, QMB is considered the secondary
category.
States are also provided an “Other” category if none of the descriptions apply to a sampled
case, e.g. a State has a CMS approved waiver and the waiver category does not fit one of the
PERM categories.
Eligibility Category Options
Families with Dependent Children (General)
SLMB
Caretaker Relative—Categorically Needy
Qualifying Individual
Caretaker Relative—Medically Needy
Qualified Disabled and Working Individuals
Children (All Ages) less than 133% Federal
Poverty Limit
Other Full Benefit Dual Eligible (FBDE)
Children (All Ages) Medically Needy
Home and Community-Based Services
Pregnant Woman
Katie Beckett
Newborn
Nursing Home
Unborn Child (Undocumented Pregnant
Woman)
Elderly Waivers
Transitional Medicaid
Family Planning Services
Aged, Blind & Disabled Categorically Needy
Women with Breast or Cervical Cancer
Aged, Blind & Disabled Medically Needy
Emergency Services (Including for NonCitizens)
SSI Recipients (Non-1634 States)
Medicaid expansion
Institutional or Hospital Care
CHIP Stand-alone
QMB
Other (None of the Above)
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Appendix B
► Universe
For each case, select Active or Negative universe.
► Stratum (only complete if stratifying)
For each case, select Stratum 1 (Applications), Stratum 2 (Redeterminations) or Stratum 3 (All
Other Cases).
► Case Action
Identify the last case action on the case that is under review. For Active Cases, enter
Application if the action on the case was to grant eligibility based on a completed application or
Redetermination if the action on the case was to redetermine eligibility based on a completed
redetermination. (Note: When submitting data directly into the PETT website, States that
stratify will only have to enter this information for Stratum 3 cases; Stratum 1 and Stratum 2
cases are pre-populated on the form based on the data provided in the Stratum field). For
Negative Cases, states should select Denial if the action being reviewed is the denial of a new
application or Termination if the action being reviewed is termination based on a
redetermination of eligibility.
► Review Month
Enter the review month for which eligibility is being verified which may not be the sample
month. In general, the review month is the month of the last action. If the last action was
more than 12 months prior to the sample month, the review month is the sample month. For
Stratum 1 (Applications) and Stratum 2 (Redeterminations) cases, the review month should be
the same as the sample month if the decision and effective dates are in the same month. For
Negative Universe cases, the review month would be the month a case was denied or
terminated.
► Review Finding
Select the letter code for the review finding (e.g., E, NE, EI, MCE1) for each case. The active
and negative case review finding codes are defined as follows:
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Appendix B
Active Cases
► E—Eligible –A case meets the State’s categorical and financial criteria for receipt of benefits
►
►
►
►
►
►
►
►
►
►
►
►
under the program
NE—Not eligible – An individual beneficiary or family is receiving benefits under the
program but does not meet the State’s categorical and financial criteria being verified using
the State’s documented policy and procedures.
EI—Eligible with ineligible services – An individual beneficiary or family meets the State’s
categorical and financial criteria for receipt of benefits under the Medicaid or CHIP program
but was not eligible to receive particular services in accordance with the State’s documented
policies and procedures
U—Undetermined—The case record lacks or contains insufficient documentation, in
accordance with the State’s documented policies and procedures, to make a definitive
review decision for eligibility or ineligibility
L/O-SD—Liability overstated-spend down – The beneficiary overpaid toward a spend
down amount and the State underpaid
L/O-BP—Liability overstated-beneficiary premium – The beneficiary overpaid toward a
beneficiary premium and the State underpaid
L/O-O—Liability overstated-other – The beneficiary overpaid toward an assigned liability
amount or cost of institutional care and the State underpaid
L/U-SD—Liability understated-spend down – The beneficiary underpaid toward a spend
down amount and the State overpaid
L/U-BP—Liability understated-beneficiary premium – The beneficiary underpaid toward a
beneficiary premium and the State overpaid
L/U-O—Liability understated-other – The beneficiary underpaid toward an assigned
liability amount or cost of institutional care and the State overpaid
MCE1—Managed care error, Ineligible for managed care –- Upon verification of
residency and program eligibility, the beneficiary is enrolled in managed care but is not
eligible for managed care
MCE2—Managed care error, Eligible for managed care but improperly enrolled ––
Beneficiary is eligible for both the program and for managed care but not enrolled in the
correct managed care plan as of the month eligibility is being verified
X—Dropped – Case is dropped from the sample. Sampling situations that might cause a
State to adjust the sample and the universe after it has already been pulled include when:
A case is found to be under active beneficiary fraud investigation
A case should have been excluded from the sampling universe but was included
inadvertently in the universe and sampled (e.g., a State-only case was sampled)
A case was enrolled in Medicaid or CHIP using States’ Express Lane Eligibility option,
set forth in Section 1902(e)(13) and Section 2107(e)(1) of the Social Security Act
(although these cases should be coded in a way that they could be excluded from the
sampling universe)
► TE-ACT—Technical error active universe – PERM review found an error in the case that
did not affect eligibility or result in an improper payment
Note: If a case is identified in the sample under the above conditions, or other circumstances not
listed here that may warrant a drop, please contact CMS and the SC before making a resubmission.
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Appendix B
This will help CMS identify the scope of any sampling concerns and provide the appropriate guidance
for how to proceed.
Negative Cases
► C—Correct – The negative case was properly denied or terminated by the State
► ID—Improper denial – An application for program benefits was denied by the State for not
meeting a categorical and/or financial eligibility requirement but, upon review, is found to be
eligible for the tested category or a different category under the program in accordance with
the State’s documented policies and procedures
► IT—Improper termination – During a redetermination, the State determined that an existing
beneficiary no longer met the program’s categorical and/or financial eligibility requirements
and was terminated but upon review is found to have been eligible for the tested category or
a different category under the program in accordance with the State’s documented policies
and procedures
► X—Dropped – Case is dropped from the sample. Please contact CMS and the SC when a
case needs to be dropped
► TE—Technical error negative universe – PERM review found an error in the case that did
not affect the state’s decision to deny or terminate the case
► Cause of Error
Enter the cause of the error for findings other than Eligible or Correct. For each error, select
the appropriate cause of error from the drop-down list. The Cause of Error options are
provided below.
For cases that are found to have more than one cause of error, CMS leaves discretion to the
States to identify the primary cause of error. For cases where more than one aspect of
eligibility cannot be verified, the State should select “Eligibility Criteria Cannot be Verified.”
The list of PERM error causes is not all-inclusive. If cases are in error based on agency or
client circumstances that are not listed here, States may select one of the “Other” error
causes.
Active Case Options
Income: Client Failed to Report Countable
Income
Citizenship/Identification/Residency: Case
Record Missing Citizenship/Identity Doc
Income: Agency Failed to Collect
Appropriate Income Verification
Citizenship/Identification/Residency: Agency
Failed to Accept Appropriate
Citizenship/Identification Doc
Income: Agency Miscalculated Countable
Income
Citizenship/Identification/Residency:
Residency Cannot be Determined
Income: Other
Citizenship/Identification/Residency: Recipient
is Not a State Resident
Assets: Agency Failed to Accept Appropriate
Asset Verification
Citizenship/Identification/Residency: Other
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Appendix B
Active Case Options
Assets: Agency Miscalculated Countable
Assets
State Procedure: Application is Incomplete
Assets: Client Failed to Report Countable
Assets
State Procedure:
Missing/Insufficient/Inconsistent Case Notes
Assets: Other
State Procedure: Missing Pregnancy
Verification (Eligibility/Technical Error)
Household Composition: Person Improperly
Included/Excluded from Budget Group
State Procedure: Beneficiary Premium
Payment Miscalculated
Household Composition: Agency Accepted
Inappropriate Verification of Household
Composition
State Procedure: Recipient in Wrong Medicaid
Category
Household Composition: Other
State Procedure: CHIP Case not Properly
Screened for Medicaid Eligibility
Third Party Liability (TPL): Client Failed to
Report TPL
State Procedure: Agency Failed to Accept
Appropriate Self Declaration
Third Party Liability (TPL): TPL Failed to Pay
Applicable Medical Expenses
State Procedure: Other
Third Party Liability (TPL): Client Ineligible
Due to TPL
Eligibility Criteria Cannot be Verified
Third Party Liability (TPL): Other
Negative Case Options
Recipient Not Given 10 Day Advance Notice
Case Not Evaluated for Transitional
Medicaid/Medicaid Extension
Notice had Incorrect Denial/Termination
Reason
Case Terminated Without Evaluation for Other
Medicaid Category
Missing Case Record
Other
Agency Failed to Act on Timely Verification
► Optional Cause of Error Detail
Use this is a free text entry field to enter the cause of any error or technical error that did not
result in a payment error. The field can also be used to enter additional information, if
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Appendix B
necessary, to clarify the selected Cause of Error code. This field is required for cases with a
“Technical Error” review finding.
Note: Per the PERM eligibility guidelines, technical errors are errors identified during the
eligibility review that do not affect the eligibility of a case for a given program (Medicaid or
CHIP) and would not result in a difference between the amount that was paid and the amount
that should have been paid on behalf of the sampled case.
► Total Dollars
For all Active Universe cases except those with a Review Finding of Undetermined (U), enter
the total dollars the State paid for services received in the sample month for each case. It
includes payments to a provider, insurer or managed care organization for the program and for
the services received.
► For fee-for-service cases, enter the total amount of dollars paid for the beneficiary based on
►
►
►
►
claims for services received at any time through the sample month and paid in that month or
the four subsequent months, allowing 60 days for adjustments
For managed care cases, enter the capitated amount paid for the case. All managed care
payments for the sample month are included regardless of the actual payment date so long
as the coverage dates fall within the sample month and are paid by the end of the fourth
subsequent month after the sample month. Prospective capitation payments are also
included in the payment review so long as the prospective payment is applied to the
beneficiary’s coverage in the sample month
Do not include payments made by the beneficiary.
Place a zero in this column if the State did not make any payments for the sample month.
Place a zero in this column if the review finding for the case is Undetermined.
► Total Dollars in Error
For all Active Universe cases not found to be Undetermined, enter the amount of payment that
is in error based on each case’s:
►
►
►
►
►
Ineligibility for the program
Ineligibility for the services received
Liability overstated or understated
Ineligibility for managed care
Eligibility for managed care but enrollment in the wrong managed care plan
(e.g., the difference in the amount managed care capitation payment for which the case is
eligible, if any)
Enter the portion of the total payments, in whole or in part, that was in error for each sampled case.
For cases that involve an incorrect calculation of beneficiary spend down, contribution to care or
beneficiary-paid premium to the state, enter the difference between what the beneficiary was told to
pay/contribute versus what the beneficiary should have been told to pay/contribute. Please contact
CMS or The Lewin Group for additional guidance on liability errors.
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Appendix B
For cases that are found to have both an error in the beneficiary premium calculation and an error for
any other reason (e.g., Eligible with Ineligible Services), Total Dollars in Error would equal the sum of
these two errors.
Place a zero in this column if there is no payment amount in error or if the review finding for the case
is Undetermined.
► Total Dollars Correct
For all Active Universe cases except those with a Review Finding of Undetermined (U), a
correct payment amount is a payment to a provider, insurer or managed care organization
based on the case’s eligibility for the program and for the services received under the
coverage group for which the case is eligible as defined in the State’s plan.
► For fee-for-service cases, enter the total amount of dollars paid for the beneficiary based on
claims for services received at any time through the sample month and paid in that month or
the four subsequent months, allowing 60 days for adjustments
► For managed care cases, enter the capitated amount paid for the case. All managed care
payments for the sample month are included regardless of the actual payment date so long
as coverage dates fall within the sample month and are paid by the end of the fourth
subsequent month after the sample month. Prospective capitation payments are also
included in the payment review so long as the prospective payment is applied to the
beneficiary’s coverage in the sample month
Enter the portion of the payments, in whole or in part, as appropriate, that were correct for each
sampled case. Place a zero in this column if there is no correct payment amount.
Do not include payments made by the beneficiary.
Place a zero in this column if the review finding for the case is Undetermined.
► Total Dollars Undetermined
For all Active Universe cases that are found to be Undetermined (based on a case not having
the verification necessary to make an eligibility review decision), enter the total amount of
payments associated with the case. Place a zero in this column if the case is not
undetermined.
Note: While reported separately on the PETT website, Total Dollars Undetermined is included
in the error rate calculations. Total Dollars Undetermined is combined with Total Dollars to
obtain the Sample Paid Amount. Total Dollars Undetermined is combined with Total Dollars in
Error to obtain the Sample Error Amount. (On the PETT website, States also have the option
to calculate the error rates with undetermined cases excluded as errors. In those instances,
Total Dollars Undetermined is not added to Total Dollars in Error.)
Leave payment columns blank if a case is dropped and leave payment columns blank for all negative
cases.
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Appendix C
Appendix C: PERM Eligibility Summary Case Review Findings Form
Payment Error Rate Measurement (PERM) Eligibility Reviews: Summary Findings
Categories
Summary Details
A. State
B. Date
C. Program
Number Number Number Number Number
Number of
Total
Total
Total
Total
of
of
of
of
of Cases
Cases
Dollars Dollars Dollars
Dollars
Cases in
Cases
Cases
Cases Incorrect Undetermined
Paid
Correct
in
Undetermined
Universe Sampled Dropped Correct
Error
from
Sample
D. Active
Stratum 1
Stratum 2
Stratum 3
E. Negatives
Denials
Terminations
F. Totals
I certify that this information is accurate and that the State will maintain the sampled case records used in the calculation of the
eligibility error rate for a minimum period of three years from this date. I understand that this information may be subject to Federal
review and that our sampled case records are subject to Federal audit.
Signature:
Date:
State Medicaid or CHIP Director or Designee
Appendix C: PERM Eligibility Summary Case Review Findings Form
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Appendix D
Appendix D: PERM Eligibility Summary Case Review
Findings Form Line by Line Instructions
► Line A: State
Enter the name of the State participating in the PERM program that is submitting this
report.
► Line B: Date
Enter the date the Summary Findings form is being submitted to CMS (e.g. July 1,
2010).
► Line C: Program
Enter the program for which the Summary Findings form applies (e.g. Medicaid or
CHIP).
► Line D: Active
Enter information on all active cases from across the twelve sampling months of the
PERM cycle. An active case is a case containing information on beneficiaries who are
enrolled in the Medicaid or CHIP program in the sample month.
Stratum 1—Applications: Enter information on all Stratum 1 active cases from
across the twelve sampling months of the PERM cycle.
Stratum 2—Redeterminations: Enter the information on all Stratum 2 active
cases from across the twelve sampling months of the PERM cycle.
Stratum 3—All Other Cases: Enter the information on all Stratum 3 active cases
from across the twelve sampling months of the PERM cycle.
Please note that the rows with the three eligibility strata are not used if a State decides
not to stratify the eligibility universes and samples.
► Line E: Negative
Enter the appropriate information on all negative cases from across the twelve sampling
months of the PERM cycle. A negative case is a case containing information on a
beneficiary who applied for benefits and was denied or whose program benefits were
terminated based on the State agency’s eligibility determination.
Denials: Enter the appropriate information on all cases where the State rejected
an application for not meeting categorical and financial eligibility requirements.
Terminations: Enter the appropriate information on all cases where the State took
an action to termination program eligibility when an existing beneficiary no longer
meets eligibility requirements.
► Line F: Totals
Enter the total number of cases and dollars in each column. For example, in column one,
sum the total number of active cases and the total number of negative cases and in
column two, sum the total number of active and negative cases sampled.
For each row described above, enter the appropriate numbers in each column as
follows:
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Appendix D
► Number of Cases in the Universe Column
Enter the number of cases in the universe subject to sampling for the months reviewed
throughout the fiscal year. These cells should be left blank in the Denials and
Terminations rows because States are not required to collect this level of information.
► Number of Cases Sampled Column
Enter the number of cases sampled in each of the categories described in the rows
above (when applicable).
► Number of Cases Dropped from Sample
Enter the number of cases excluded from the sample due to the acceptable reasons
given in the PERM eligibility guidance in each of the categories described in the rows
(when applicable). These should equal the number of dropped cases reported on the
monthly PERM Eligibility Review Findings form.
Note: In the Summary Review Findings form on PETT, the Number of Dropped Cases is
not counted in the Sample Number of Cases which only reflects the number of cases
that were reviewed by the State.
► Number of Cases Correct Column
Enter the number of cases deemed to be correct through the PERM eligibility reviews in
each of the categories described in the rows (when applicable).
For active cases, the column should equal the number of cases reported on the PERM
Eligibility Review Findings forms completed throughout the fiscal year with a review
finding of E-eligible, EI-eligible with ineligible services, L/O-liability overstated, L/Uliability understated, MCE1-managed care error, ineligible for managed care or MCE2eligible for managed care, but improperly enrolled.
The State should not include any cases with a review finding of U—undetermined in this
column.
For negative cases, the column should equal the number of denied and terminated
cases reported on the PERM Eligibility Review Findings forms completed throughout the
fiscal year with a review finding of C—correct.
► Number of Cases Incorrect Column
Enter the number of cases deemed to be incorrect through the PERM eligibility review in
each of the categories described in the rows.
For active cases, the column should equal the number of cases reported on the PERM
Eligibility Review Findings forms completed throughout the fiscal year with a review
finding of NE—not eligible.
The State should not include any cases with a review finding of U—undetermined in this
column.
For negative cases, the column should equal the number of cases reported on the
PERM Eligibility Review Findings forms completed throughout the fiscal year with a
review finding of either ID—incorrect denial or IT—incorrect termination.
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► Number of Cases Undetermined Column
Enter the number of cases for which the State was unable to determine eligibility in each
of the rows (when applicable).
For active cases, the column should equal the number of cases reported on the PERM
Eligibility Review Findings forms completed throughout the fiscal year with a review
finding of U-Undetermined.
The cells should be left blank in the Negative, Denials and Terminations rows because
Undetermined review findings do not apply to negative cases.
► Total Dollars Paid Column
Enter the total dollars paid that corresponds with each of the categories described in the
rows (when applicable).
The cells should be left blank for Undetermined cases which are reported separately.
The cells should be left blank in the Negative, Denials and Terminations rows because
payment reviews are not completed for negative cases.
► Total Dollars Correct Column
Enter the total dollars paid correctly that corresponds with each of the categories
described in the rows (when applicable).
The cells should be left blank for Undetermined cases which are reported separately.
The cells should be left blank in the Negatives, Denials and Terminations rows because
payment reviews are not completed for negative case.
► Total Dollars in Error Column
Enter the total dollars paid in error that corresponds with each of the categories
described in the rows (when applicable).
The cells should be left blank for Undetermined cases which are reported separately.
The cells should be left blank in the Negatives, Denials and Terminations rows because
payment reviews are not completed for negative cases.
► Total Dollars Undetermined Column
Enter the total dollars associated with all cases cited as Undetermined for each of the
categories described in the rows (when applicable).
The cells should be left blank in the Negative, Denials and Terminations rows because
payment reviews are not completed for negative cases and undetermined cases are not
associated with negative cases.
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Appendix E
Appendix E: PERM Eligibility Medicaid and CHIP Timeline
Appendix E: PERM Eligibility Medicaid and CHIP Timeline
Page 37
| File Type | application/pdf |
| File Title | PETT 2.0 Web Application Project User Guide |
| Subject | CMS PERM |
| Author | The Lewin Group |
| File Modified | 2013-05-16 |
| File Created | 2013-05-16 |