New Claims Editor – Zelis

Effective April 1, 2020, EmblemHealth has partnered with Zelis Healthcare to introduce a new editing tool that provides fast, accurate, and customized claims editing, while being fully compliant with ever-changing guidelines. 

Zelis uses robust technology and analytics to effectively review claims for billing errors prior to payment so you may see new edit codes and explanations.

Zelis will initially apply edits to EmblemHealth’s HMO Commercial and Medicare products using industry standards sourced to the Centers for Medicare & Medicaid Services (CMS), the American Medical Association, and the ICD-10-CM manual. Zelis’ suite of edits complements the system currently in place.

To learn more about the claims software solutions we have in place, please visit the Claims Chapter of our Provider Manual and review the Claims Review Software section.