Corrective Action Plan Template And Instructions Page 3
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11Payment Error Rate Measurement (PERM)
CHIP Corrective Action Summary
A. (State) ____________________________________ Fiscal Year: ___________________
B. (Date) _____________________________________
C. State Contact: ______________________________
Phone number: _________________________
Email address: _________________________
D. CHIP Error Rate: _________________________
Fee-for-service rate: ____________________
Managed care rate: _____________________
Eligibility payment rate: _________________
E. Summary of Error Causes and Applicable Corrective Actions
CHIP
Fee-for-service:
Error Causes: _______________________________________________
Corrective Actions: __________________________________________
Managed care:
Error Causes: _______________________________________________
Corrective Actions: __________________________________________
Eligibility:
Error Causes: _______________________________________________
Corrective Actions: __________________________________________
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