eAudit to Generate Reports for Claims under Complex Medical Review

Electronic Audit (eAudit) is a new 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.