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

OMB 0938-1012

The Improper Payments Information Act (IPIA) of 2002 requires CMS to produce national error rates for Medicaid and SCHIP. To comply with the IPIA, CMS needs the information to be collected in order to provide some Federal overview of state eligibility determinations to ensure correctness and consistency among states and to use the State-specific error rates as the basis for calculating national eligibility error rates for Medicaid and SCHIP.

The latest form for Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (CMS-10184) expires 2020-06-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CMS-10184 Summary of Eligibility and Payment Review Findings Form and Instruction
Form CMS-10184 Reporting Individual Payment Findings Form
Form CMS-10184 Reporting Individual Review Findings Form
Form CMS-10184 Monthly Sampling Lists Form
Form CMS-10184 Reinstatement of Prior Burden Estimates for CMS-10184E Form and Instruction
Form CMS-10184 Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Form and Instruction
CMS - 10184 - Supporting Statement - Part A - Eligibility_PERM 080224.docx Supporting Statement A
CMS - 10184 - Supporting Statement - Part B - Eligibility.docx Supporting Statement B
Corrective Action Report
Summary of Eligibility and Payment Review Findings Form and Instruction
Reporting Individual Payment Findings Form
Reporting Individual Review Findings Form
Communications and Review Support
Monthly Sampling Lists Form
Pre-cycle Report
Reinstatement of Prior Burden Estimates for CMS-10184E Form and Instruction
Payment Error Rate Measurement - State Medicaid and CHIP Eligibility (MEQC Substitution) Form and Instruction

All Historical Document Collections

202408-0938-027	Reinstatement with change of a previously approved collection	2024-08-28
202405-0938-026 Comment filed on proposed rule	Reinstatement with change of a previously approved collection	2024-05-28
201609-0938-031 Approved without change	Extension without change of a currently approved collection	2016-10-03
201310-0938-003 Approved with change	Reinstatement with change of a previously approved collection	2013-10-25
201007-0938-002 Approved without change	Revision of a currently approved collection	2010-07-13
201002-0938-008 Approved without change	Extension without change of a currently approved collection	2010-02-26
200908-0938-004 Approved without change	Revision of a currently approved collection	2009-08-12
200810-0938-006 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-10-06
200711-0938-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2007-11-15
200611-0938-008 Approved with change	New collection (Request for a new OMB Control Number)	2006-11-22

OMB Details

Sampling Plan

Federal Enterprise Architecture: Health - Health Care Services

Form CMS-10184

Monthly Sample Selection List

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.