Healthcare 101
The clinic, hospital, doctor, laboratory, healthcare practitioner, or pharmacy that provides medical services.
Provider
The Zelis service Professional claims run through
Claims Editing:
What other claim can run through Claims Editing
How often should you update your team's pipeline report
Twice a month
The claim cost reduction Zelis achieves sitting in a second position for claims editing
1-3%
The documents needed for Bill Review and Audit
Operative Report
Itemized Bill
UB Claim
For 100 extra points, who retrieves the documents?
The amount of money charged by an insurance company for coverage
Premium
The four focused audits
Billing & Coding Compliance
Chart Audit
Cost Analysis
Policy Adherence
Where and IA request is filled out
Salesforce
Turnaround time for claims editing
Near real time (minutes)
Product that provides against protection against catastrophic or unpredictable losses?
Stop Loss Insurance
For 200 extra points, name and describe the two types of stop loss insurance
The members shared cost of a covered healthcare service calculated as a percent of the allowed amount for the service
Coinsurance
The 3 secured savings channels for OON
Continuous Discount Agreement
Supplemental Networks
Negotiations
For 300 extra points, explain each channel
Where the data for an IA needs to be placed
Internal FTP site
For 100 extra points describe how to get to the FTP site and how it should be organized
How many providers are opted in to the Zelis electronic payments network?
580,000
Zelis Payments Electronic Product Offerings
Virtual Card
ACH
For 200 extra points, describe each product
The insurance company takes the risk. Groups may be pooled with other, and all services come from the selected carrier, such as the network billing, and claim payments
Fully Insured Plan
Zelis' Reference Based Pricing Options
ERS
Percent of Medicare
Who is the head of the Impact Analysis Team
Chris Stebbins
For an additional 100 point, who is his right hand man
Bill Review Turnaround time
12-15 days
The number of PPO networks Zelis has access to
Over 150
For 150 extra points, explain the difference between using Supplemental networks as an out of network, versus in network.
The process of paying claims submitted or denying them after comparing claims to the benefit or coverage requirements. Consist of receiving a claim from an insured person, and then utilizing software to process claims.
Adjudication Systems:
For 100 extra points, which system is Zelis a preferred partner?
The Net Cost of a Claim Process
Zelis applies code edits, uses benchmark analytics, review historical data, and performs a clinical review to get an OON claim to the appropriate amount before sending it to one of our savings channels
Describe how to submit and impact analysis from start to finish
Demonstrate on screen.
How many nurse auditors do we have on staff?
Over 60
List all the products Zelis offers
1) Network Analytics & Design
2) Network Access
3) Claims Editing
4) Clinical Bill Review and Audit
5) Dialysis Savings & Support
6) OON Services
7) Reference Based Pricing
8) Electronic Payments