eAudits: Generate Reports for Claims Under Medical Review

Published 10/10/2018

Electronic Audit (eAudit) is a new function available in the eServices online portal. This tool gives you the ability to access personal reports of audit results for claims that have been chosen for Medical Review by various Medicare review contractors. eAudit also lets you see what claims may be pending for 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 that contains the most common denial reasons. The eAudit tool currently features CERT contractor claim review data and Railroad Medicare Medical Review data. Railroad Medicare Appeal review data is 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. Once there, select the Audit Type and the screen will populate with a summary table of audit data. 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 at www.PalmettoGBA.com/eServices. eServices is available to providers who have an EDI Enrollment Agreement on file with Palmetto GBA Railroad Medicare.   

Example of eAudit Claim Data Table in eServices

Audit Type

MAC Medical Review Status

CERT Claim Review Status