Summary of Eligibility and Payment Review Findings

Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184)

⚠️ Notice: This information collection may be referencing outdated material.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-10184 Summary of Eligibility and Payment Review Findings Form and Instruction
CMS-10184 Monthly Sample Selection List -CMS-10184.Monthly Sample Selection List.doc Form and Instruction

Information Collection (IC) Details