Ensure accurate payments with Zelis.
Ensure the accuracy and integrity of claims – before you pay. Pre-pay payment integrity solutions ensure a positive financial experience for your providers and reduce billing inaccuracies for your members.
Fortify your payment integrity in the face of new pressures and complexities: discovering savings earlier that stick the first time, with an eye towards the future to help you prepare for, and navigate, evolving requirements and bill provider trends.
Leading Performer in 2023 KLAS inaugural Payment Accuracy & Integrity Solutions Report
KLAS, a leading independent healthcare analyst firm, recently profiled 8 Payment Integrity vendors through hours of direct customer interviews, vendor briefings, and market insights. The result is a comprehensive view of the payer payment integrity landscape, and Zelis is the top-rated vendor.Read the Report
Payment Integrity Suite
Customizable solutions that ensure provider payments are accurate and appropriate.
Uncover coding errors and inappropriate charges with itemized bill review, clinical chart review, and DRG validation in a pre- or post-pay environment.
- Experience superior service with solutions led and supported by remarkable healthcare experts.
- Customize reviews to align with plan policies, regulations and provider contractual provisions.
- Reduce provider abrasion with comprehensive pre-pay reviews to pay the claim right the first time and not impact provider revenue cycle while also offering post-pay reviews for those more complicated or restrictive reviews that cannot be done before claim payment.
Improve payment accuracy with a holistic approach to claims editing, using a combination of a growing library of edits, historical data, industry knowledge, and the expertise of a team of certified professional coders, registered nurses, and medical doctors.
- Pay claims on time when they are right and deny when there are potential errors.
- Leverage our Clinical Coding Policy expertise to enhance your operations and identify and enforce claims that fall within the clinical gray areas.
- Optimize revenue opportunities with expert analysis and recommendations on your claims payments and trends.
- Reduce claim appeals with adherence to coding standards.
- Customize claim editing process to meet in-house guidelines.
total cost savings
Let’s talk about modernizing your business.
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.Connect with us
Top Resources on Payment Integrity
3 Reasons To Provide Positive Healthcare Payment Experiences
Health plan members expect positive healthcare payment experiences. Here are three ways health plans can benefit.View resource
5 Questions to Ask Your Claims Editing Vendor
Take a look at your current claims editing vendor partner and subsequent workflows and ask this question: “What else can we be doing?”View resource
5 Ways Healthcare Payers Can Improve Provider Satisfaction
Simplifying healthcare payments can deliver numerous benefits to both providers and members.View resource