Zelis reviews more than $140 billion in claims.

We combine leading-edge, machine learning-enabled technology with superior clinical expertise and integrate network, claims and payments data to generate insights that drive actions that maximize claims cost savings.

We maximize claims cost savings by finding and reducing provider errors, waste and abuse using our proprietary claims editing, specialty clinical audits, dialysis savings, clinical bill review and audit and out-of-network solutions.

CLAIMS EDITING

Generating fast, accurate, industry-compliant claims analysis.

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CLINICAL BILL REVIEW & AUDIT

Uncovering coding errors and inappropriate charges.

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SPECIALTY CLINICAL AUDITS

Review of specialty Rx, complex spinal and biologic implants and air ambulance claims.

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DIALYSIS SAVINGS & SUPPORT

Maximizing savings for high cost dialysis claims.

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OUT-OF-NETWORK SERVICES

Ensures optimal cost-savings on out-of-network claims.

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reference based pricing

Reference Based Pricing

Delivers sustainable cost management that goes beyond cost shifting.

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