June 20, 2025

Effective June 15, 2025, we are partnering with Zelis to conduct inpatient prospective and retrospective hospital bill reviews on claims which will include requests for itemized bills and/or medical records to verify charges billed.

• Itemized Bill Review – Detailed review of itemized bills to identify billing and coding discrepancies. Errors identified include duplicate charges, unbundling, incidental supplies, and much more.
• Clinical Chart Review – Robust reviews conducted by Certified Coders and/or Clinicians to identify billing, clinical, and coding discrepancies.

These detailed reviews will be conducted by Certified Coders to identify billing and coding discrepancies; errors identified include, but are not limited to, duplicate charges, unbundling, incidental supplies. Identified errors will result in the reprocessing of the claim to adjust the charge amount to align with the review findings. This could result in a payment adjustment.

If you receive a request for review from Zelis, please ensure you follow the instructions outlined in the letter, which also includes contact information directly to Zelis. If you have additional questions, please contact our Provider Services Helpline at 1-888-991-9023.

Thank you for being a valued provider for members in one or more of our health plans: Health Partners Plans Medicaid, Health Partners Plans CHIP, Jefferson Health Plans Medicare Advantage, and/or Jefferson Health Plans Individual and Family Plans.