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.
We help you reduce friction for your providers and members while controlling the rising cost of care. Zelis partners with more than 25 Blues plans, improving the healthcare journey for more than 95 million members. Our solutions are purpose-built to uphold all BCBS® Association and ITS requirements, and configurable to adapt to future Blues mandates and requirements.
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.
Our relationship with Zelis has given us the flexibility to create customized solutions and bring value to our clients. The solutions and expertise that Zelis brings to the table, as well as its team’s ability to develop ideas to improve our processes, have created a mutually beneficial relationship for both our companies.
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
Debunking Common Reference-Based Pricing (RBP) Misconceptions
While it may seem straight-forward, there are still quite a few misconceptions about RBP. Get the facts in our latest blog here.
View resourceBlog
MRFs: The Trouble with (and Solution to) Some of Healthcare’s Biggest Cost Problems
On their own, MRFs are difficult, if not impossible, to understand or use. That’s where Zelis Healthcare Insights 360 comes into play.
View resourceNews
Zelis® Unlocks Power of Price Transparency Data to Control Rising Costs of Healthcare with Healthcare Insights 360â„
Healthcare Insights 360 delivers actionable insights into market rates and powers competitive networks for healthcare consumers.Â
View resourceBlog
Understanding Reference-Based Pricing (RBP)
As healthcare costs rise, RBP is positioned to become an increasingly popular alternative to traditional healthcare network models.Â
View resourceNews
Zelis Launches Reference-Based Pricing Solution that Prioritizes Members;Â Aligns Experience and Cost ContainmentÂ
Zelis® launches reference-based pricing solution that prioritizes members and aligns member experience and cost containmentÂ
View resourceBlog
Are IDR disputes really what’s holding you back from major savings?
With the CMS’ latest IDR regulations, you’re going to need a vendor who can do more than just “keep you out of disputes.”
View resource
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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.
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