Identifying billing and coding accuracy.
Zelis uses leading-edge technology combined with expert insight to analyze claims and identify billing and coding accuracy by cross-referencing claims history and claims data. Evaluating more than 14 million claims each year, our fast, accurate results are fully aligned with industry-recognized guidelines, ever-changing compliance requirements and our client’s unique needs. And all of this is completed before any payments are made. Moreover, Zelis can manage all appeals or a portion, depending on your preference—however, less than 5% of edits that are utilized are ever appealed.
- Encompasses over 18 million highly customizable edits that are sourced to national coding standards making them reliable and defensible
- Claims Edit logic uses historical data
- Customizable to align with your unique payment, benefit and medical policies
- Management of industry updates
- Client specific customizations done at no cost
- Consultative approach and hands on client implementation with dedicated staff
- Consistent review of data & trends to identify future edits and policies
- Expertise of CPCs, RNs & MDs
- Proactive Reviews vs. Reactive Appeals
- Customized rules target specific claim scenarios to ensure accurate application of code edits and to maximize savings
- Targets created based on trends and client payment policies
- High return on investment