Pay healthcare claims at the right time, every time.
Improve payment accuracy with a holistic approach to claims editing.
Proactively identifying billing errors is proven to reduce overpayments and provider abrasion, all while improving savings. That’s why we examine every claim using a combination of a growing library of edits, historical data, industry knowledge, and the expertise of a team of certified professional coders, registered nurses, and medical doctors.
As we continue to pay for care with care, intentional solutions that are customizable to your workflow are critical. Zelis Claims Editing is designed to fit your claims processing and payments workflow where you need it. Our out-of-the box approach provides a flexible solution that ensures timely, accurate payments.
Whether you need a first-pass editor or a secondary one, Zelis Claims Editing fits in your workflow to ensure you are capturing the most savings possible.
Customizations and edit optimization ensure your edit rules are staying up-to-date with regulatory changes, in-house policies, and unique provider contracts.
Regularly updated to adhere to national coding standards and enhanced by the Office of the CMO and a team of clinical experts, including physicians and nurses.
Pre-payment review drives timely and accurate payments
The combination of tech-enabled workflows and hands-on expert reviews ensures each claim gets the proper level of review it warrants, ensuring each claim is treated like the unique patient story it is.
For Healthcare Payers & Third-Party Administrators (TPAs)
Zelis Claims Editing enables you to:
For Blues Plans
Zelis Claims Editing suite is designed to:
Zelis by the Numbers
Measurable savings on every claim:
Claims Editing in action.
“Our total savings in just the past year topped $4.1 million resulting in $24.98 PEPM savings. A huge benefit is the ability to customize edits for specific services. Being able to turn edits off and on by client or even apply them down to the provider level has assisted us immensely.”
– Mary, COO of TPA
“Working with Zelis has helped us take an end-to-end approach to problems starting with pre-payment, looking at the best way to pay those claims initially to get the best pricing available. We work with Zelis from pre-payment through sending the payment.”
– Steve, COO of TPA
“They have excelled at finding large dollar overpayments that have enabled us to exceed our goals.”
– Angela Manager at National Health Plan