{"id":7030,"date":"2021-10-29T18:24:49","date_gmt":"2021-10-29T18:24:49","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=7030"},"modified":"2021-10-29T18:24:49","modified_gmt":"2021-10-29T18:24:49","slug":"zelis","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/zelis\/","title":{"rendered":"Zelis"},"content":{"rendered":"<p>Back in February 2019, Health New England announced our partnership with Zelis to review claim submission against industry-recognized guidelines and to ensure compliance with proper coding principles.<\/p>\n<p>As part of the review and on behalf of Health New England, Zelis sends appropriate letters when they need further review of the claim information. In some cases, those letters are asking to obtain medical records to further support their review. In these letters, it states to send medical records as soon as possible, but historically, the medical records have not been arriving in a timely manner and in most cases, it requires Zelis to follow up multiple times with the provider.<\/p>\n<p><strong>With that said, effective 1\/1\/2022, the letters will now state if the medical records or business records are not provided back within 45 calendar days from receipt of the letter, this will result in a denial of referenced claim.<\/strong><\/p>\n<p>In addition, providers have a right to appeal with Zelis. If your Explanation of Payment states: \u201cZR: Pay: Paid in accordance to Zelis Adjustment\u201d, you need to contact Zelis directly at (866) 489-9444. For more information on working with Zelis, please see below:<\/p>\n<p><img data-recalc-dims=\"1\" decoding=\"async\" class=\"aligncenter size-full wp-image-7031\" src=\"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2021\/10\/Zelis.png?resize=556%2C598\" alt=\"\" width=\"556\" height=\"598\" srcset=\"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2021\/10\/Zelis.png?w=556 556w, https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2021\/10\/Zelis.png?resize=279%2C300 279w\" sizes=\"(max-width: 556px) 100vw, 556px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back in February 2019, Health New England announced our partnership with Zelis to review claim submission against industry-recognized guidelines and to ensure compliance with proper coding principles. As part of the review and on behalf of Health New England, Zelis sends appropriate letters when they need further review of the claim information. In some cases, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-7030","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/s6ZZHB-zelis","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/7030","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=7030"}],"version-history":[{"count":1,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/7030\/revisions"}],"predecessor-version":[{"id":7032,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/7030\/revisions\/7032"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=7030"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=7030"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=7030"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}