May 6 2025 Pre-Eligibility Medical Expenses Reminders

May 6, 2025: Attention Skilled Nursing Facility, Hospice, and Inpatient Providers: This is an update to the June 20, 2024, alert regarding PEME (Pre-Eligibility Medical Expenses). PEMEs are unpaid medical expenses incurred in the three months prior to the application for Medicaid. To view the PEME segment, log into CHAMPS, click on the member tab, and select eligibility inquiry.

A PEME is considered to have an approved status when there is a 0 amount and an end date matching the eligibility inquiry end date submitted.

Additional reminders:

• A PEME displaying a 0 amount does not require the provider to request a correction to the PEME amount or PPA amount.
  • The PEME amount will remain 0 until there is an exact partial payment amount to end the PEME.
• For a beneficiary with an approved PEME AND a PPA amount displayed within CHAMPS eligibility inquiry, both amounts must not be reported on the claim.
• The PPA dollar amount should be reported on the claim when there is no approved PEME information.
  • However, if there is no approved PEME segment but there is a PPA segment with a dollar amount listed, the PPA dollar amount must be reported on the claim.

  PEME example within the CHAMPS member eligibility screen: