Zelis^® for Health Plans

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.