Bill Review

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

Catch errors pre-payment.

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 both itemized bill review and clinical chart review 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.

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:

10 %

average savings from itemized bill review

52 %

average savings from clinical chart review

Testimonials

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

Take the Next Step

Learn how Zelis Bill Review enables more accurate payments.

Connect with Zelis