How Zelis Handles Claims Submissions and Payouts
Zelis Payments provides a comprehensive platform design to simplify and smooth healthcare providers’ entire claims processing lifecycle. From initial claim handling submission to final payouts, Zelis offers advanced tools and technology. It helps ensure accurate, timely and efficient processing. Now explore how Zelis handles claims submissions and payouts ensuring a smoother experience for healthcare providers:
1. Claims Submissions Through Zelis
The claims submission process is important part of healthcare billing and Zelis facilitates seamless, HIPAA compliant submission process. Here’s how it works:
Electronic Claims Submission
Zelis enables healthcare providers to submit claims electronically between secure, automated systems. The electronic submission process helps ensure to claims are delivere faster and with fewer errors compared to traditional paper claims. The steps involved in submitting claims via Zelis are:
- Prepare Claims: Providers submit claims the are pre validated for accuracy using Zelis built in claim scrubbing tools ensuring the coding and patient information are correct before submission.
- Submit Electronically: Claims are transmitted directly to insurance payers through HIPAA compliant Electronic Data Interchange, ensuring fast and secure method of processing.
- Monitor Submission Status: Once the claims are submitted providers track them in real time using Zelis claim tracking system. It allows providers to stay updated on whether claims are accepted, denied or pending. It offers transparency in the process.
Paper Claims Submission (if applicable)
For instances when electronic submission is not possible, Zelis also supports paper claims submission. However, electronic claims are encouraged due to their faster processing times and reduced chances of error.
2. Claims Validation and Scrubbing
Once claims are submitted, Zelis’ platform automatically runs them through a rigorous validation process known as claim scrubbing. This process involves:
- Automated Error Detection: Zelis checks claims for common coding errors, missing data, or inconsistencies. Providers are notified immediately if issues are detected allowing them to correct errors before resubmission.
- Payer specific Requirements: Zelis ensures the claims meet the specific formatting and documentation requirements of each payer. It reduces the likelihood of claim rejections due to non compliance.
3. Claim Adjudication and Payouts
Claims submitted and validated are adjudicated by the payer. Zelis is the key for facilitating the payout process, by processing the flow of claims data and reducing communication among healthcare providers and payers.
Adjudication Process
During adjudication insurance payers assess the claims submit to determine the appropriate reimbursement based on the patient’s coverage the services provided and the payer’s policies. Zelis assists providers by:
- Tracking Adjudication Status: Providers track the progress of each claim ensuring they are aware of when payments are expected.
- Real-Time Updates: If the claim is under review or requires additional information Zelis sends real time notifications so providers take prompt action.
Payment Processing
Once the claim is approve during the adjudication process Zelis facilitates the payment processing:
- Electronic Funds Transfer: Zelis works with payers to ensure the payments are made through EFT providing secure and rapid transfers directly into the healthcare provider’s bank account.
- Payer Remittance Advice: Alongside the payment providers receive detail remittance advice through Zelis. The advice includes breakdown of how the payment was calculated, the services covered and any adjustments made.
Handling Denied Claims
If the claim handling is denied Zelis offers tools to help resolve the issue efficiently:
- Real Time Denial Alerts: Providers are immediately alert to any denied claims.
- Denial Management Tools: Zelis provides denial codes and detailed explanations of why claim handling was denied. The information helps providers understand the reason for the denial and take the necessary steps to appeal or correct the claim.
4. Payout Timeliness and Efficiency
Zelis focuses on providing timely payouts to ensure the healthcare providers are paid fastly for the services they’ve rendered. The system aims to minimize payment delays by:
- Accelerating Payment Cycles: Zelis helps shorten the time from submission to payout via streamlined electronic submissions and integration with payers.
- Expedited Payer Processing: Zelis works closely with insurance companies to ensure the payments are processed without unnecessary delays.
5. Transparency and Reporting
One of the key features of Zelis’ claims processing system is its transparency. Providers have access to:
- Real Time Claim Tracking: Providers may monitor the status of their claims at any point in the process from submission to payout.
- Detailed Reports and Analytics: Zelis generates reports and gives providers insight into their claims performance. It helps them identify trends, claim rejection reasons and opportunities to improve future claims submissions.
Read Also: What is Claim Dispute? How to Handle Claims Disputes within Zelis
6. Optimizing Claims Processing with Zelis
Zelis offers features to ensure optimal claims processing efficiency:
- Automated Claim Submission: Automation reduces manual work lowering the risk of errors and improving submission speed.
- Integrated Revenue Cycle Management: Zelis integrates by provider’s existing RCM systems. It offering end to end visibility of the entire revenue cycle from patient intake to final payment.
- Compliance Assurance: Zelis ensures all claims are processed in compliance with industry regulations. It including HIPAA so providers focus on care rather than administrative tasks.