Claims Optimization
Optimize networks, maximize savings on every claim while minimizing provider friction.
Zelis® for Health Plans
Protect payment integrity, boost network savings, drive payments efficiency and earn lasting trust.
Explore Solutions Built for Health Plans
Payments Optimization
Streamline payments, gain operational efficiencies and strengthen provider and member trust.
Member Communications
Navigate complexity and cut compliance risk – move faster and scale further.
Member Engagement
Guide members to the best quality care, reducing medical costs and improving affordability.
Network Management
Build, maintain and optimize high-performing networks.
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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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Better Outcomes Before IDR: A TPA Case Study in NSA Performance
Explore how to use AI and automation improve healthcare claims management and how collaborating with experts can help.
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B2B Provider Payments: Customer Success (ZAPP + ZAPP Edge)
Learn how one payer reached 70% EFT adoption, cut $400K in print and postage costs, and improved operations using advanced payment solutions.
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Proven Savings with SmartShopper
Discover the findings of the Wakely report, highlighting savings of $552 through SmartShopper participation and care transparency.
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Resources for Health Plans
P&C Medical Payments: Stop the Fragmentation
Bodily injury now tops 26% of auto claims costs. See the 4 fault lines driving P&C medical payment fragmentation — and how a connected model fixes it.
Payment Integrity’s AI Moment: IDC Spotlight
See how AI is shifting payment integrity from post-pay recovery to pre-pay prevention. Download the IDC Spotlight report to see what's next.
The Infrastructure Behind Clear Member Communications
Clear EOBs, ID cards and enrollment materials start with connected claims data, compliance expertise and resilient operations behind the scenes.
Health Plans’ Frequently Asked Questions
Zelis helps healthcare payers manage costs and improve the financial experience across the claims pricing and payment lifecycle. Our solutions support payment integrity by identifying savings opportunities and reducing improper payments, improve claims pricing through network and out-of-network cost management, enable streamlined and simplified payment experiences to providers and members, and simplify member communications with clear, accurate explanations of benefits and payment information. By connecting these capabilities, Zelis helps payers reduce administrative complexity, improve accuracy, and deliver better experiences for providers and members.
Yes. Zelis focuses on post-adjudication pre-payment workflows where claims can be reviewed for errors and optimized for savings. Our AI-enabled capabilities apply edits and route claims through multiple savings channels to make quality recommendations to payers resulting in sustainable savings. We also work with health plans to build quality and cost-effective provider networks to deliver care to their members. Last, our leading payments platform, Zelis Advanced Payments Platform℠, reduces complexity and costs by offering a single point of control to manage all provider and member payments and communications.
Zelis helps spot errors and savings opportunities before claims are paid, making the process cleaner and more accurate.
Yes. Zelis supports smarter network planning, stronger access and clearer insight into network performance.
Keep reading: Network Management Solutions
Zelis helps health plans navigate complexity and improve member engagement with their member communications, and guides members to affordable, high-quality care, reducing medical costs and influencing the healthcare decisions that matter most.
Keep reading: Member Engagement Solutions
Health plans and national carriers work with Zelis to lower the cost of care without losing sight of provider relationships or the member experience. Zelis uses AI-native technology and advanced analytics to deliver configurable claims pricing and payment integrity solutions with connected data, healthcare expertise, and that uncover savings, reduce administrative burden, and improve cost-management accuracy at scale. More than a vendor, Zelis acts as a proactive partner invested in each health plan’s long-term success.
