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