Simple Claims Adjudication

Malike once dreaded claims adjudication. Each claim required completing arduous tasks like verifying claim eligibility, checking past payment histories, and cross-referencing network discounts. Malike found adjudication a labor-intensive process fraught with challenges exacerbated by an ever-evolving environment of provider networks, discount plans, and regulation. Malike knew better methods existed but assumed his organization’s infrastructure limited options to optimize workflows. 

 

Enhancing User Experiences

Remove obstacles and empower action

Removing unnecessary paper records from the healthcare financial chain offers numerous advantages. From reduced overhead to better data security, paperless record keeping is a boon for trimming operations costs while improving user value. Let Zelis guide your platform to peak optimization with a suite of APIs that improve operational efficiency.

Use Case Featured APIs

  • Price Optimization QuickReprice

Zelis APIs

Optimizing daily operations

Or so he thought. When Malike’s organization integrated Zelis’s Price Optimization QuickReprice API, his opinion of claims management significantly improved. The QuickReprice tool uses innovative technologies, backed by industry experts, to clear common obstacles with claim adjudication and management. Zelis takes on the challenging work of incorporating CMS and AMA’s latest industry technology updates, ensuring maximum capture of savings opportunities.

Accuracy brings peace of mind

Malike is also confident in the tool’s accuracy. He knows Price Optimization QuickReprice reviews all claim lines against patient and provider histories. Plus, Zelis’s post-adjudication, pre-payment interface utilizes Ebix Health support, is built with LuminX, and is backed up by Zelis’s latest industry data and trend analytics.

API Solution

Full support and custom configuration

The Zelis QuickReprice API offers providers a precision claims management tool optimized for accuracy and enhancing savings opportunities with customization options for your operations. Zelis’s dedicated team can configure all Payor customizations, like plan policy, medical policy, and provider contracts, to streamline integration.

Zelis Enables Users

Efficiency Exemplified

Billing Transparency

Reduce the cost and hassle associated with billing and claims discrepancies. Digital records add transparency and convenience to the healthcare financial space.

Automated Accuracy

Minimize support queues and optimize business operations through fully automated and accurate claims adjudication. 

Rapid Error Correction

Catch and resolve billing errors to increase fulfillment and reduce operational waste.

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