Uncover coding errors and inappropriate charges with expert pre-payment claim review.
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.
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.
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.
Zelis Bill Review enables you to:
Zelis by the Numbers
Measurable savings on every claim:
Bill Review in action.
“Working with Zelis has helped us take an end-to-end approach to that problem starting with pre-payment, looking at the best way to pay those claims initially to get the best pricing available. Through the end-to-end continuum that Zelis offers we have an opportunity to work with them from pre-payment right through the payment.”
– Todd, Manager at Regional Health Plan
“They have excelled at finding large dollar overpayments that have enabled us to exceed our goals.”
– Angela, Manager at National Health Plan