PERM Audit Information for ForwardHealth Providers

Every three years, the Centers for Medicare & Medicaid Services (CMS) performs a federally mandated Payment Error Rate Measurement (PERM) audit of Wisconsin health care programs. During the PERM audit, CMS selects a sample of claims and conducts a medical review to determine if services reflected in those claims were necessary and that all applicable ForwardHealth policies, procedures, and regulations related to those services were both accurately documented and provided.

Starting in mid-April, the first round of providers on those selected claims will be contacted by phone to inform them of the upcoming request for medical documentation. After the initial phone call, CMS will send letters to the previously contacted providers. The providers must respond within 75 calendar days of receipt. In the event that CMS does not receive a response, the Wisconsin Department of Health Services Office of the Inspector General may pursue recovery of payment for those claims.

To ensure that there are no delays in communication, please review your ForwardHealth contact information and confirm that all information listed is accurate and up to date.

For more information on the PERM audit, visit the Payment Error Rate Measurement Resources page of the ForwardHealth Portal. The page includes links to PERM provider resources, such as request letter samples, overview materials, and FAQs.