Corrective Action Plan Template And Instructions Page 2
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11Payment Error Rate Measurement (PERM)
Medicaid Corrective Action Summary
A. (State) ____________________________________ Fiscal Year: ___________________
B. (Date) _____________________________________
C. State Contact: ______________________________
Phone number: _________________________
Email address: _________________________
D. Medicaid Error Rate: _____________________
Fee-for-service rate: ___________________
Managed care rate: ____________________
Eligibility payment rate: _______________
E. Summary of Error Causes and Applicable Corrective Actions
Medicaid
Fee-for-service:
Error Causes: _______________________________________________
Corrective Actions: __________________________________________
Managed care:
Error Causes: _______________________________________________
Corrective Actions: __________________________________________
Eligibility:
Error Causes: _______________________________________________
Corrective Actions: __________________________________________
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