Solutions / Payment Integrity / Claims Editing
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Claims Editing

Fast, precise edits deliver savings and compliance with changing regulations.

Claims Editing Product UI

Identify errors pre-payment with Claims Editing.

The best approach to identifying billing errors is to spot them prior to payment. We examine every claim using a combination of millions of edits, historical data, industry knowledge, and the expertise of a team of certified professional coders, registered nurses, and medical doctors.

Edits are customized to align with each plan’s in-house medical, benefit and payment policies, and consistently reviewed and updated to identify future edits and ensure compliance with CMS and other nationally recognized sources.

This is not another added layer of administrative burden: it’s fully integrated into your core claims processing system, delivering the perfect balance between accuracy, savings and provider and member satisfaction.

Today, over 160 payers trust Zelis to deliver targeted and efficient edits post-adjudication and pre-payment. Our claims processing platform delivers complete flexibility and customization, alongside maximum savings, all post-adjudication and pre-payment.

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Post-Adjudication, Pre-Payment

Streamline implementation and keep claims processes intact through integration with all major adjudication platforms. Ensure accuracy – before payment – with over 18 million customizable and continuously updated edits to find savings and reduce the costs incurred with pay-and-chase scenarios.

National Coding Standards

Ensure reliability and defensibility of all edits.

Customizable Edits

Target specific claim scenarios to ensure accurate application of edits per payment policies and trends.

Clinical Oversight

Review claims proactively, with insight from CPCs, RNs and MDs.

For Payers

Zelis Claims Editing enables you to:

  • Integrate claim edits into pre-payment processes
  • Find new claims savings opportunities proactively
  • Reduce claim appeals with adherence to coding standards
  • Customize claim editing process to meet in-house guidelines

Zelis by the Numbers

Measurable savings on every claim:

80 %
of claims contain coding or other errors
< 5 %
of Zelis claims edits are disputed
< 2 %
of Zelis claim edits are reversed

Testimonials

Claims Editing in action.

Take the Next Step

Learn how Zelis Claims Editing uncovers savings every day.

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