Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0938-1012 can be found here:

Documents and Forms

Document Name Document Type
Form CMS-10184A Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Form and Instruction
CMS-10184A Cases Selected for Review: Monthly Sample Selection List CMS 10184A MEQC substitution 7-8-09.doc Form and Instruction
CMS-10184B Detailed Active Case Review Findings CMS 10184B MEQC substitution 7-8-09.doc Form and Instruction
CMS-10184E Summary Findings CMS 10184E MEQC substitution 7-8-09.doc Form and Instruction
CMS-10184 Negative Case Review Findings 10184 Negative Case Review Findings.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CMS-10184A	Cases Selected for Review: Monthly Sample Selection List	CMS 10184A MEQC substitution 7-8-09.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10184B	Detailed Active Case Review Findings	CMS 10184B MEQC substitution 7-8-09.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10184E	Summary Findings	CMS 10184E MEQC substitution 7-8-09.doc	Yes	Yes	Fillable Fileable
Form and Instruction	CMS-10184	Negative Case Review Findings	10184 Negative Case Review Findings.pdf	No	No	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	407,094	407,094
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.