July 10, 2026

Zelis® Named a Leader in Everest Group’s Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026

Recognition validates Zelis’ connected approach to payment integrity as payers accelerate the shift from retrospective recovery to pre-payment accuracy.

Boston, M.A. — Zelis®, a leading provider of healthcare technology solutions, has been named a Leader in the Everest Group Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026. 

The timing reflects a meaningful shift in how health plans are approaching claims accuracy. Payers are moving payment integrity activity upstream, addressing potential errors before claims are paid rather than chasing recoveries after the fact.  Zelis’ connected pre-payment integrity approach helps health plans identify potential inaccuracies before payment, reduce avoidable administrative work and support a smoother experience for providers. 

News Summary

  • Zelis, a pioneer in pre-payment integrity, rises to become a first-time Leader on the Everest Group Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026.
  • Everest Group cited Zelis’ depth across claims editing and expert claims review, including high-volume workflows and the ability to address complex areas such as itemized bill review.
  • Clients recognized Zelis’ broad product offering, customization depth and partner-led model that supports multiple pre-payment integrity needs.

“When payers can identify claims issues before payment, they can reduce waste, avoid unnecessary rework and keep more healthcare dollars focused on care,” said Jon Grandstaff, General Manager of Payment Integrity at Zelis. “Being recognized as a Leader by Everest Group reflects our longstanding role as a pioneer in pre-payment integrity, as well as our continued investment in AI, automation and other advanced technologies that help clients make more accurate payment decisions earlier. This recognition underscores the progress we have made against our vision to strengthen payment integrity across the claims lifecycle.”

What Everest Group Found

Everest Group evaluated technology providers on market impact, vision and capability. Leaders in this category are defined by scaled pre-payment programs, mature buyer relationships and the ability to support high-volume claims environments across health plan types. 

In its assessment of Zelis, Everest Group highlighted: 

  • Depth across claims editing and expert claims review, supporting both high-volume edit workflows and complex areas such as itemized bill review 
  • Strong traction with third-party administrator (TPA) buyers, alongside established relationships with large scale national and regional health plans 
  • A customizable, partner-led engagement model that lets clients address multiple pre-payment integrity needs through a single vendor relationship 

“Pre-payment integrity is becoming more connected to pricing, routing, and review decisions as payers look to prevent leakage earlier and manage claims with greater precision,” says Ankur Verma, Vice President, Everest Group. “Zelis has strengthened its pre-pay proposition through the Zelis Intelligent Pricing Platform (ZIPP), which unifies payment integrity and claims pricing under a single ingestion point, an architecture that lets editing and pricing decisions inform each other rather than run as separate workflows. This is backed by their claims editing and expert claims review capabilities that support both high-volume edits and more complex areas such as itemized bill review. Its established presence among TPAs, combined with experience across health plan types and sizes, coupled with client recognition for its broad product offering and customization, contributed to Zelis’ positioning as a Leader in Everest Group’s Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026.” 

A Deliberate Shift — From Reactive to Prevention-First

As medical costs rise and health plans face growing pressure to reduce administrative waste, payers are increasingly looking to address potential claims inaccuracies before payment rather than relying on post-pay recovery. 

Everest Group estimates the pre-payment integrity outsourced market at $3–4 billion in 2025, with expected compound annual growth of 10–12% over the next several years. This is a sign of how quickly the industry is moving toward upstream accuracy and away from reactive recovery models. 

Zelis is built for this shift. Its AI-enabled pre-payment integrity portfolio includes Zelis Claims Editing, Zelis Expert Claims Review® – both supported by an Intelligent Claims Routing Platform®. Together, these solutions help payers catch inaccuracies earlier, reduce reliance on retrospective recovery and create a better experience for providers. The portfolio is part of Zelis’ end-to-end cost containment ecosystem that enables payers to maximize claims accuracy and optimizing claims pricing seamlessly.  

This recognition is part of a broader strategic direction for Zelis as it builds toward a future where payers do not have to choose between operational efficiency and payment accuracy because the capabilities are connected from the start. 

About the Everest Group PEAK Matrix® Assessment

The Everest Group Pre-payment Integrity Solutions PEAK Matrix® Assessment 2026 evaluated 28 providers and classified them as Leaders, Major Contenders or Aspirants based on market impact and vision and capability. 

Learn more about Zelis’ pre-payment integrity capabilities by reading the report.

Additional Resources

About Zelis

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top 5 national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

Learn more at Zelis.com and follow us on LinkedIn to get the latest news.

About Everest Group

Everest Group is a leading global research firm helping business leaders make confident decisions. Everest Group’s PEAK Matrix® assessments provide the analysis and insights enterprises need to make critical selection decisions about global services providers, locations, and products and solutions within various market segments. Likewise, providers of these services, products, and solutions, look to the PEAK Matrix® to gauge and calibrate their offerings against others in the industry or market. Find further details and in-depth content at www.everestgrp.com. 

Disclaimer

Licensed extracts taken from Everest Group’s PEAK Matrix® Reports may be used by licensed third parties for use in their own marketing and promotional activities and collateral. Selected extracts from Everest Group’s PEAK Matrix® reports do not necessarily provide the full context of our research and analysis. All research and analysis conducted by Everest Group’s analysts and included in Everest Group’s PEAK Matrix® reports is independent and no organization has paid a fee to be featured or to influence their ranking. To access the complete research and to learn more about our methodology, please visit Everest Group PEAK Matrix® Reports.