Oklahoma Ranks Among the Best in the Nation for Medicaid Eligibility and Claims Payment Accuracy

Oklahoma City, OK – The Oklahoma Health Care Authority recently completed a 2022 Payment Error Rate Measurement (PERM) review with the Centers for Medicare & Medicaid Services (CMS). PERM issues an error rate that measures how accurately state Medicaid programs process claims and determine eligibility.

Oklahoma’s 2022 PERM error rate was 1.95%, which was the second lowest rate in the nation and is significantly below the national average of 15.62%.

“OHCA prioritizes compliance and fiscal responsibility to ensure every dollar we spend goes toward authorized services for eligible members,” said OHCA CEO, Kevin Corbett. “I am proud of the commitment of our team to protecting taxpayer funds, while providing members swift access quality care.”

The PERM program uses a 17-state, three-year rotation cycle for measuring improper payments and ineligibility. Each state is measured once every three years. Oklahoma is a Cycle 1 state, measured in 2022 and will be measured again in 2025.

SoonerCare Eligibility Determination

SoonerCare applications are processed by validating an applicant’s data through several eligibility requirements and information exchanges built into the electronic application. The application process instantly provides a decision regarding the applicant’s eligibility. SoonerCare processes between 20,000 and 30,000 applications per month. Oklahoma was the only state to process and conduct 100% of applications in less than 24 hours during the first three months of 2022.

Throughout the member’s eligibility, OHCA performs a system of checks, data exchanges, and audits to ensure reported eligibility information is accurate. The eligibility error rate for 2022 was 1.95%.

SoonerCare Claims Payment

OHCA’s claims processing system contains an extensive set of edits used to ensure the accuracy of claims before payment. OHCA utilizes control processes such as prior authorizations, suspended claim reviews, post payment reviews, and payment accuracy measurement studies to ensure the integrity and accuracy of claims. The claims error rate for 2022 was 0%, the lowest payment error rate in the history of OHCA.