Clinical Bill Review & Audit

Uncovering coding errors and inappropriate charges.

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 pre-payment approach includes a full-scope clinical and financial analysis which focuses on our core elements of billing compliance, cost analysis and chart review while ensuring claims adhere to plan policy requirements and billing standards.

  • Chart Audits and Specialty Clinical Audits of in and out-of-network claims with a focus on clinical accuracy, cost to charge analysis, adherence to billing compliance and medical necessity validation
  • 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