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Solutions / Payment Integrity / Claims Editing
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Claims Editing

Pay healthcare claims at the right time, every time.

Talk to us about Claims Editing
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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.

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Flexible Solution

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.

Customizable Edits

Customizations and edit optimization ensure your edit rules are staying up-to-date with regulatory changes, in-house policies, and unique provider contracts.

Content

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:

  • Pay claims on time when they are right and deny when there are potential errors
  • Optimize revenue opportunities with expert analysis and recommendations on your claims payments and trends
  • Reduce claim appeals with adherence to coding standards
  • Customize claim editing process to meet in-house guidelines

For Blues Plans

Zelis Claims Editing suite is designed to:

  • Fit into your existing workflows when and where you need it
  • Adhere to Association mandates
  • Reduce your internal and external administrative burden
  • Address atypical edit categories that lie within the clinical gray areas
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Zelis by the Numbers

Measurable savings on every claim:

< 5 %
of Zelis claims edits are disputed
< 2 %
of Zelis claim edits are reversed

Testimonials

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

Take the Next Step

Learn how Zelis Claims Editing uncovers savings every day.

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