eAudit to Generate Reports for Claims under Complex Medical Review

Published 12/31/2018

Electronic Audit (eAudit) is a function available in the eServices online portal which allows providers the ability to access personal reports of audit results for claims which have been chosen for Complex Medical Review by various Medicare review contractors.

eAudit gives providers the opportunity to see what claims may be pending Complex Medical Review currently and the results of any recent review decisions.

This information can be used for self-assessment of provider performance on Medicare audits utilizing a dashboard which contains the most common denial reasons. The eAudit tool currently features CERT contractor claim review data with JM Medicare Administrative Contractor (MAC) Medical Review and JM Appeal review data coming soon.

How do I use the eAudit function?
To get started, log into the eServices portal using your user ID and select the eAudit tab, which is located under the eReview tab. The screen will automatically populate with a summary table of your CERT audit data by error code category. Full details can be found in the eServices User Guide (PDF, 7.69). 
If you don't already have an eService account, register for one today

Example of eAudit Claim Data Table in eServices

Example of eAudit Claim Data Table in eServices

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