Claims Editing

Generating fast, accurate, industry-compliant claims analysis.

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.

Leading Edge Technology

  • More than 40+ edit categories aligning with industry recognized guidelines and standards
  • 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

Expert Insight

  • 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