Focus on clinical edits to begin negotiations with diagnosis code triggers.
Claims Negotiations with Zelis
Our skilled negotiators, clinical and coding experts work collaboratively to optimize appropriate out-of-network reimbursement, pre- and post-payment, while maintaining strong relationships.
Achieve reasonable and transparent reimbursement.
We use advanced technology to identify claims that require negotiation, averaging 65% savings from claim negotiations. It’s a clinically focused approach that looks at factors including medical necessity and experimental or investigational therapies.
While some claims may be negotiated automatically, others are routed to our skilled and tenured team. Their deep clinical and financial expertise leads to real savings – without violating PPO contracts. All negotiations result in a letter of agreement, including both clinical and coding findings.
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There’s no shortage of ways we can help. Get a conversation going with one of our Solution Advisors and build a thoughtful approach aligned to your business goals.
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