Bill Review with Zelis

Fortify your payment integrity operations with a bill review solution built by healthcare experts. Bringing remarkable service from remarkable people to our pre-pay bill review offering, we offer a solution built for your reality.

Dive Deeper

Send more accurate payments with bill review.

Bill Review was once something that healthcare payers could ‘set and forget,’ but those dynamics have shifted. Payers must now fight competing pressures: balancing cost of care for both members and providers, all while navigating ecosystem-wide pressures driven by thinning margins and evolving regulations. The complexity is greater, and the stakes are higher.

Uncover coding errors and inappropriate charges with expert pre-payment claims review by a team of experienced clinicians, including nurses, physicians and certified coders that review inpatient and outpatient medical claims to ensure claim payment accuracy.

Our pre-payment approach uses itemized bill review, clinical chart review, and diagnoses related groups (DRG) validation with a full-scope clinical and financial analysis to focus on billing compliance, cost analysis, financial outliers, and adherence to plan policies and billing standards.

Features and Benefits

Ensure the accuracy and integrity of claims, before you pay.

Identify duplicate charges, unbundling, incidental supplies, deviation from CMS and industry standard billing guidelines and more with itemized bill review.

Examine the clinical accuracy of billed charges on complex claims via an audit conducted by a team of clinicians, including niche claims such as Specialty Rx, Implants and Air Ambulance with clinical chart review.

Conduct clinical review of MS-DRG and APR-DRG claims that impact Medicare and Medicaid reimbursement, including principal and secondary diagnoses, procedure codes, and discharge status.

By the Numbers

Measurable savings on every claim.


average savings rate per claim for Itemized Bill Review


average savings rate per claim for Clinical Chart Review


average savings rate per claim for DRG Validation

Our relationship with Zelis has given us the flexibility to create customized solutions and bring value to our clients. The solutions and expertise that Zelis brings to the table, as well as its team’s ability to develop ideas to improve our processes, have created a mutually beneficial relationship for both our companies.
Our team recommends Zelis to any third-party administrators that are seeking a partner that will help them deliver superior service, provide strong cost reduction solutions, and continually looks for ways to improve its products and services.
Zelis has always given us the tools we needed to succeed. Working with their team has helped us navigate the constantly changing demands of the market that are generated by our clients’ needs, regulatory issues, and the passage of new legislation. We have a level of confidence that when something new comes up, we’re going to work with Zelis to solve the problem.

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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.

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