Modernize operations
We help you in your digital transformation journey, as a connected platform or with purpose-built solutions.
Zelis® for Payers
Scale and grow with an independent partner that’s willing to deeply understand and flex to your business through deep visibility across the financial ecosystem of healthcare.
Payer Use Cases
Optimizing your performance and modernizing your business.
We believe the key lies in creating stronger connections between you, your providers, and your members – and we’re building the technology and processes that are making it happen. By addressing the most abrasive aspects of the payments process, we’re purposefully evolving your existing process to help you reduce friction and control the rising cost of care.
As healthcare costs continue to rise, and as new regulations take effect across the country, there’s more pressure than ever on property and casualty carriers. Zelis is here to bring you a tailored single-point solution that includes electronic payments, balanced network design, and leading-edge analytics to auto and worker’s compensation plans.
No one else in the industry gives TPAs more tools to integrate network analytics, network access and management, payment integrity, electronic payments, and member communications.Â
The result? Deep insights that lead drive clarity, savings, and efficiency at every step. We’re looking at the entire claims process, starting at pre-payment, to help you spot errors early and uncover savings opportunities less integrated solutions might miss. We’re also helping you proactively build and optimize your network, ensuring you’re delivering the coverage your members need.
Your clients value your input – and Zelis can help you make your relationships even stronger. Partner with us, and we’ll put the industry’s most advanced analytic tools at your fingertips.
Zelis Network Analytics allows you to consult with your clients on a whole new level. You’ll bring competitive and performance insights to the table, uncovering gaps in their networks and comparing their network performance to key competitors. You’ll bring real insights to the table – insights health plans and TPAs can use to improve member service, optimize network performance, and reduce costs.
Key Use Cases
- Proven track record of results in claim and payment savings.
- Deep expertise and analytics in network performance, access and care guidance.
- Digital-first intuitive care shopping, selection, and rewards.
- Ability to balance risk and financial performance.
- Flexible financial models that align to mutual success.
From the start, Network360® has been a wildly successful program that has impacted our ability to meet goals and grow our business.
Zelis has always given us the tools we needed to succeed. Working with their team has helped us navigate the constantly changing demands of the market that are generated by our clients’ needs, regulatory issues, and the passage of new legislation. We have a level of confidence that when something new comes up, we’re going to work with Zelis to solve the problem.
Zelis listens to our business needs and growth strategy, and anticipate how ACS can continue to deliver results for our clients. We have a comprehensive partnership across many different solutions, and we are continuing to expand.
Top Resources for Payers
Blog
Accelerating Progress in Healthcare Finance: A Call to Action
Zelis drives healthcare financial change through innovation, data and payment optimization. Solutions built for real healthcare challenges.
View resourceWhite Papers
The Network Analysis Pyramid
Understand the importance of network analysis in healthcare to address rising healthcare insurance costs.
View resourceBlog
From Fragmented to Fluid: A Total Experience Approach to Provider Network Management
See how healthcare organizations can remedy fragmented care using provider network analytics, integrated experience strategies and AI-supported solutions.
View resourcePlaybooks
What Current Payment Integrity Trends Mean for Health Plans
Explore the latest Payment Integrity Trends shaping the future of financial transactions and compliance in the industry.
View resourceBlog
Overview: Transparency in Coverage Schema 2.0 Regulatory Update
CMS unveils TiC Schema 2.0 with key MRF changes to boost efficiency, cut file size and guide payers toward smoother compliance by 2026.
View resourceBlog
Denial Management in Healthcare: Turning Data into Action
Providers are constantly stuck reacting to claim denials. Discover how claim analytics can help them shift to a proactive denial management strategy.
View resourceCase Studies
From $156K to $430: 
A Health Bill Win That Earned Member Trust
See how Zelis Health Bill Assist® saved the day on a member’s $156k out-of-network medical bill.
View resource
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There’s no shortage of ways we can help. Get a conversation going with one of our Solution Advisors and build a thoughtful approach aligned to your business goals.
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