October 13, 2026

Payer-Provider Alignment: Closing the Payment Gap

Yusuf Qasim, President, Payments Optimization

Why Payment Workflows Still Create Friction

Administrative complexity remains one of the most expensive, least visible problems in healthcare. Every unresolved claim, every rework cycle and every delayed remittance adds cost somewhere in the system, even when both sides are technically doing their jobs correctly.

The friction isn’t usually a data problem, as payers and providers both have sophisticated analytics capabilities. The disconnect happens because those insights rarely cross organizational lines. Data sharing between payers and providers consistently ranks as the lowest-adopted practice for both groups, even though both say they want it.

Misaligned incentives compound the issue. When payment accuracy, speed and transparency aren’t measured the same way on both sides, each organization optimizes its own workflow instead of a shared outcome.

Where Payment Gaps Show Up in Daily Operations

Pre-Payment Delays and Rework

Claims that don’t process cleanly the first time generate manual work that rarely disappears. It simply relocates further down the workflow, often landing on the provider’s revenue cycle team or the payer’s call center.

Inconsistent Payment Timing

Payment timing variability affects provider cash flow planning, particularly for smaller practices and health systems operating on thin margins.

Member Confusion Over Costs

Ninety-six percent of providers say is critical, but only 29% rate themselves as effective at it, even though payers typically hold the coverage data providers need.

Disconnected Claims and Payment Data

Remittance information often arrives without enough context for providers to reconcile it efficiently, forcing manual matching that both sides say they want to eliminate.

From Diagnosis to Shared Results

1. Establish transparent, data-driven communication. Payers and providers already collect similar data independently. Sharing relevant claims, denial and utilization insights, even in a small number of targeted use cases, reduces duplicated effort on both sides.
2. Align financial incentives around accuracy and timeliness. When both organizations are measured against the same definition of a “clean” payment, the workflow naturally shifts from dispute resolution toward prevention.
3. Implement integrated technology platforms. closes the loop that currently forces manual reconciliation on both ends of the transaction.
4. Create real-time feedback loops. Recurring exception patterns, not just one-off errors, are where the biggest opportunity lives. Surfacing those patterns back to the source prevents the same issue from repeating month after month.

The best denial is the one that never happens, because better information should be available before the claim was ever filed.
– Yusuf Qasim

What Concrete Action Looks Like Now

Audit Current Payment Workflows

Start with the workflows where both sides already hold relevant information. Cleaner intake, clearer documentation and faster eligibility decisionswithout requiring new systems.

Adopt Unified Payment Platforms

Visibility across the entire payment lifecycle, from adjudication to remittance to reconciliation, reduces the administrative burden both payers and providers currently absorb separately.

Build Joint Governance Structures

Ongoing collaboration, not one-time projects, sustains progress. Regular forums for reviewing shared data keep both sides accountable for the same outcomes.

Invest in Member Transparency Tools

Coverage and cost information that’s easy to understand reduces the volume of that ultimately land on provider staff.

Everyone is running analytics. The opportunity is running them together.
– Yusuf Qasim

The Bottom Line

Payment inefficiency isn’t a niche operational issue anymore. It’s a direct driver of rising costs, provider strain and member frustration, and the pressure to fix it is only growing as workforce shortages and administrative complexity compound each other.

Zelis is built to help payers and providers move past shared diagnosis toward shared results, reducing improper payments, improving transparency and strengthening the trust that makes the payer-provider relationship work for everyone involved.