Healthcare Claims Editing with Zelis®.

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.

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Dive Deeper

Improve payment accuracy with a holistic approach.

Optimize revenue opportunities with expert analysis and recommendations on your claims payments and trends, reducing claim appeals with adherence to coding standards. 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.

Features and Benefits

Incorporate technology, analytics, and clinical coding expertise.

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.

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.

By the Numbers

Measurable savings on every claim.

0

of Zelis claims edits are disputed

0

of Zelis claim edits are reversed

Our team recommends Zelis to any third-party administrators that are seeking a partner that will help them deliver superior service, provide strong cost reduction solutions, and continually looks for ways to improve its products and services.
Beverly Proctor
Beverly Proctor, Chief Operations Officer of ACS Benefit Services View case study
Zelis has always given us the tools we needed to succeed. Working with their team has helped us navigate the constantly changing demands of the market that are generated by our clients’ needs, regulatory issues, and the passage of new legislation. We have a level of confidence that when something new comes up, we’re going to work with Zelis to solve the problem.
Eric Channer
Eric Channer, Chief Financial Officer of AmeriBen View case study

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Let’s talk about modernizing your business.

There’s no shortage of ways we can help. Get a conversation going with one of our Solution Advisors and build a thoughtful approach aligned to your business goals.

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Claims Editing Resources

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News

Zelis® a Leader in Everest Group’s PEAK Matrix® Assessment 2026

Zelis rises to become a first-time Leader on the Everest Group Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026.

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White Papers

Everest Group 2026 Pre-Payment Integrity Report

Download Everest Group’s 2026 Pre-Payment Integrity PEAK Matrix report to see why Zelis was named a Leader for prevention-first payment accuracy for payers.

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Infographics

client looking at the Payment integrity vendor selection infographic

Payment Integrity Vendor Selection Infographic

Download the infographic to evaluate payment integrity partners, pressure-test ROI and connect pre-pay prevention with post-pay claims intelligence.

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