Zelis utilizes leading-edge technology and a team of clinicians to audit inpatient and outpatient medical claims to uncover coding errors and inappropriate charges. Our breakthrough approach is pre-payment, utilizing both itemized bill reviews and clinical chart reviews on claims prior to payment. This includes a full scope clinical and financial analysis which focus on our core elements of billing compliance, cost analysis and chart review while ensuring claims adhere to plan policy requirements and billing standards.
- Clinical expertise with specialty peer reviews offer concrete findings based on industry-recognized FDA guidelines and standards that focus on ensuring medical necessity and adherence to medical policies and plan guidelines
- Enhanced chart validation and assessment of claim itemization charges that are not billed accordance to compliance standards