Zelis to assist with payment integrity claim reviews for Cigna Healthcare Medicare Advantage

May 30, 2024

Cigna HealthcareSM is committed to providing efficient and accurate claims processing that is consistent with the Centers for Medicare & Medicaid Services and American Medicare Association guidance, industry standards, and our existing policies. As part of this effort, effective July 1, 2024, Zelis, a vendor that offers multipayer solutions, will assist with performing various aspects of payment integrity claim reviews in a prepayment environment for Cigna Healthcare Medicare Advantage, including:

  • Itemized bill review.
  • Clinical chart review.
  • Diagnosis-related group (DRG) validation.

As part of Cigna Healthcare fraud, waste, and abuse efforts, Zelis will perform periodic reviews of itemized bills, medical records, and other pertinent patient encounter documentation to verify billed charges against the appropriate coding, clinical validation, and DRG assignment for reimbursement.

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