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Bill Review

Uncover coding errors and inappropriate charges with expert pre-payment claim review.

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Catch errors pre-payment.

The Zelis team of experienced clinicians, including nurses, physicians and certified coders 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.

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Itemized Bill Review

Identifies duplicate charges, unbundling, incidental supplies, deviation from CMS and industry standard billing guidelines and more.

Clinical Chart Review

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

DRG Validation

Clinical review of items that impact Medicare reimbursement, including principal and secondary diagnoses, procedure codes, and discharge status. A team of clinicians review the claims and respond with DRG regrouping recommendations with clear rationale when necessary.

For Payers

Zelis Bill Review enables you to:

  • Customize audits to align with plan policies
  • Drive maximum savings
  • Avoid pay-and-chase scenarios with pre-payment reviews

Zelis by the Numbers

Measurable savings on every claim:

13 %
average savings from itemized bill review
33 %
average savings from clinical chart review

Testimonials

Bill Review in action.

Take the Next Step

Learn how Zelis Bill Review enables more accurate payments.

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