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.
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
The Data Revolution: Coming to a Healthcare Industry Near You
Amanda Eisel discusses the role each of us plays in advancing the healthcare industry and dives into the driving force behind it all: data.
View resourceBlog
Healthcare payment trends 2024: Future-proof your plan
Payers face operational pressures on multiple fronts, from rising costs to provider burnout. Those that will succeed in 2024 must embrace digital payments transformation to future-proof their plan & foster provider trust.
View resourceBlog
Medicare Star Ratings Decline Opens the Door for New Opportunities in Member Satisfaction
This year’s Medicare star ratings decline is a wake-up call, but a few strategic steps can help health plans change the game.
View resourceBlog
Don’t Count on a Second Take: Addressing Healthcare Business Risks before a Crisis
The 2023 banking crisis forced many healthcare companies to make fast decisions to protect finances. Here’s how to prevent a meltdown in the future.
View resourceLegislative Highlights
CMS Releases Final Rule on Hospital Transparency and MRF Requirements
Hospitals must meet new MRF transparency requirements. Take a look at what they are and what it could mean for you.
View resourceBlog
Reduce fraud risk by modernizing healthcare payments
As healthcare volumes continue to climb, legacy payment processes create friction for providers and patients–and they look to payers to modernize these platforms.
View resourceBlog
Healthcare Adjudication and Trends to “Watch”
Discover the future of healthcare adjudication. Learn to embrace value-based care, data analytics, blockchain security, and AI automation.
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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