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.
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.
Control rising costs, gain efficiencies and improve provider and member satisfaction for your dental organization by leveraging our connected platform for network and payment solutions.
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.
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Let’s talk about modernizing your business.
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.
Connect with usResources for Payers
How One Payer Used Market-Based Pricing to Drive Out-of-Network Savings
See how a regional healthcare payer expanded ERS market-based pricing to grow out-of-network savings while keeping provider disputes low.
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Payment Integrity Vendor Selection White Paper
See how US healthcare payers can choose the right payment integrity vendor, reduce provider abrasion and improve retained savings with smarter claims strategy.
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Going from IDR Pressure to Payer Operational Readiness
Discover how payers are preparing for the next phase of NSA and IDR demands, including rising dispute volume, operational strain and the expected IDR final rule.
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Reducing Provider Abrasion in Payment Integrity
Download the Zelis white paper to learn how payers can reduce provider abrasion with the Triple E framework: Enable, Educate, Engage.
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NSA Compliance as a Strategic Advantage | Ebook
Learn how payers can move beyond reactive No Surprises Act compliance and build a smarter NSA compliance strategy across claims, payments, and IDR operations.
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TiC 2.0 and the No Surprises Act: What Payers Need to Know
Watch CMS’s proposed TiC updates, how they align with the No Surprises Act, and what payers should do now to prepare for compliance
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