Focus on clinical edits to begin negotiations with diagnosis code triggers.
Claims Negotiations with Zelis
Blend human expertise and advanced technology to deliver high quality discounts and maintain strong relationships with providers by identifying the right claims for negotiation.
Dive Deeper
Achieve reasonable and transparent reimbursement.
Our team of highly skilled negotiators work collaboratively in a pre- and post-payment scenario with clinical and coding experts to identify maximum savings opportunities. We use advanced technology to identify eligible claims, averaging 60+% savings from negotiations. Our clinically focused approach 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.
The kind of longevity of Zelis team members can’t be overstated in this industry. So many at Zelis have been here as we faced challenging times, as well as during the many accomplishments we’ve achieved, and one of those was early in 2022 when we reached the milestone of administering benefits for over one million lives.
Request a Meeting
Explore out-of-network claims negotiations.
Let’s discuss optimizing your out-of-network claim processes. Our Solution Advisors are ready to help you develop a tailored approach that aligns with your business objectives and maximizes savings recommendations.
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