July 1, 2026
How an AI Enabled Prevention-first Approach Earned Independent Recognition — and Why it Changes the Math for Health Plans
By Jon Grandstaff, SVP/GM, Payment Integrity
Payment integrity is one of the highest-leverage investments a health plan can make and the way it’s done is changing fast. For years, plans relied on recovering improper payments after the fact: a slow, costly cycle that strains provider relationships. The market is now moving upstream toward prevention, and independent analysts are validating which payment integrity vendors are ready to accommodate that shift.
Zelis helped pioneer pre-payment integrity. That’s why we’re proud to share that Zelis has been recognized as a Leader in Everest Group’s Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026. This is our first time in the Leaders category, up from Major Contender just a year ago.
Key Takeaways
- Zelis, a pioneer in pre-payment integrity, was named a Leader in Everest Group’s Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026 — up from Major Contender in 2025.
- Zelis is innovating at a rapid pace to lead the market and independent analysts are taking note.
- The market continues to shift from retrospective pay-and-chase recovery toward prevention to catch errors before claims are paid.
- Zelis’ commitment to innovation to drive deeper insights and transparency have led to sustained value, lower administrative cost, and less provider abrasion.
A Three-year Climb
This recognition didn’t happen overnight. In 2024 Zelis was a Major Contender. In 2025 we held that tier but improved on dimensions Everest measures: market impact, vision and capabilities. This year’s Leader position demonstrates a deliberate strategy to lead with prevention, deepen our capabilities across the payment integrity value chain and prove value to the plans we serve. Zelis’ commitment to innovation and focus on sharpening its capabilities in this area are paying off, with Everest’s ranking as a proof point of our advancements.
For years, payment integrity mostly meant chasing dollars after the fact. It’s the familiar pay-and-chase cycle. It works, but it’s slow, administratively expensive and a frequent source of provider friction. Zelis spent more than a decade reimagining the pre-pay space and setting the standard for it. The industry is now moving upstream to catch errors, waste and improper billing before a claim is ever paid. The most valuable dollar saved is the one never paid in error.
Where Zelis Payment Integrity Stands Out
Prevention-first, not pay-and-chase.
Pre-payment editing and reviews flag issues before a claim is paid, so plans pay accurately the first time with fewer downstream recoveries, lower administrative cost and far less provider abrasion. Download the Provider Abrasion whitepaper.
Depth across the full value chain.
Claims editing, clinical and coding validation, itemized bill review, DRG validation, complex clinical reviews, high-cost drug solutions and repricing, brought together with one partner and one data foundation, not stitched-together point solutions.
Analytics that learn.
AI-enabled detection works across large claim volumes to surface patterns and improper billing that rules alone would miss – and gets sharper as data grows.
Connected by design.
Payment integrity sits inside the broader Zelis cost containment ecosystem that already serves a large share of the U.S. payer market with cleaner data hand-offs, a smoother provider and member experience, and greater transparency end-to-end. Learn more about our Zelis Intelligent Pricing Platform®.
Why Independent Recognition Matters to Payers
Payment integrity decisions are rarely made by one person. They involve provider and network management, claims, IT, legal and clinical stakeholders – each focusing on risk, compliance and measurable ROI. In that environment, an outside opinion carries weight. Independent recognition validates capability claims against the broader market, reduces procurement risk during RFP and vendor review cycles and gives executives a credible signal to support investment decisions. When the stakes include audit exposure, provider relationships and millions in claims cost, third-party validation is part of doing diligence well.
The Bottom Line
Payment integrity sits at the intersection of Medical Loss Ratio (MLR) needs, compliance and provider relationships. A partner that prevents improper payments is worth more than one that only recovers them. Independent recognition from Everest Group signals that prevention-first isn’t just our point of view. It’s where the market is heading.
Explore Our Payment Integrity Solutions
See how a prevention-first approach can work for your plan. Explore our Payment Integrity solutions or request a demo with our team.
Disclaimer
Licensed extracts taken from Everest Group’s PEAK Matrix® Reports may be used by licensed third parties for use in their own marketing and promotional activities and collateral. Selected extracts from Everest Group’s PEAK Matrix® reports do not necessarily provide the full context of our research and analysis. All research and analysis conducted by Everest Group’s analysts and included in Everest Group’s PEAK Matrix® reports is independent and no organization has paid a fee to be featured or to influence their ranking. To access the complete research and to learn more about our methodology, please visit Everest Group PEAK Matrix® Reports.
