Create innovative and competitive network structures.
Build, access, manage, and optimize competitive, high-performing networks. Sustain your competitive edge and unlock new business opportunities with our competitive network solutions.
Why Zelis?
Networks that meet your goals.
Our proven data analytics platform leverages provider and competitor data with the ability to layer in additional data elements from your organization or our partners to help you build, access, manage, and optimize your networks.
Key Points
- Access high-confidence, comprehensive provider network data
- Understand your competitive position to win
- Ensure an optimal mix of providers for increased member satisfaction
- Access local, national, and specialty networks to expand provider coverage and deliver member savings
Network Solutions Suite
Modularized solutions to take your networks beyond limitations.
Accessibility – Measure access and minimum provider ratios for individual physicians and facilities, both in your own and in competitors’ networks.Â
- Compare network access side-by-side with targeted competitors.
- Identify provider gaps and create custom provider recruiting lists to fill those gaps.
Disruption – Gain a competitive edge in the sales process with integrated competitor data within your disruption analysis.
- Benchmark against competition to underscore your strengths and proactively mitigate weaknesses.
- Unlimited licenses ensure speed to needed information and the ability to run multiple disruption scenarios.
Competitive Benchmarking – See how your network compares to your competitors.
- Gain market intelligence to better position yourself against competitors with side-by-side comparisons that show overlap and exclusivity by geography and top specialties.
View average monthly volatility: Monitor your competitors’ provider network activity over time
Access the right provider coverage with customizable network solutions that drive in-network savings and mitigate out-of-network costs.
- Access credentialed, logoed primary networks with visibility into performance against claim spend.
- Expand your coverage for out of service areas with wrap and secondary networks that support your current setups.
- Search for the highest discounts and minimize member noise with supplemental networks that use the Zelis ClaimPass solution.
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The Zelis Provider Network Data Process
Zelis collects data from hundreds of plans and thousands of networks. This disparate data comes in many forms, making meaningful comparisons across networks a challenge. Zelis specializes in organizing and managing this data to support network analytics that you can rely on.
Audit, Processing & Matching:
- Audit: Zelis performs a thorough audit to ensure we have all providers, their locations, specialties, and any additional provider information needed for analysis.
- Processing: The data is cleaned and prepared for matching. This includes standardizing the data to USPS standards and creating consistent specialty designations.
- Matching: A key element in Zelis’ process is our proprietary algorithm for matching providers across disparate data sources. This occurs at both the provider level and the provider location level, resulting in persistent identifiers for both.
- Integrate: Network360 is data agnostic and can integrate additional data elements such as cost and quality to support plan design and optimization decisions.
- Delivery: The dataset is then delivered through our intuitive analytics platform with clear data visualization tools.
As we’ve worked with Zelis, we’ve found all their capabilities and solutions to be very easy to plug-in and integrate with our offerings. That flexibility is very valuable to us.
Zelis truly puts their money where their mouth is. They understand the value of partnership, and that everything in this business is driven by relationships.
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.
Connect with usTop Resources on Network Solutions
Blog
2023 State of the Market: A look into the provider network landscape
Dive into the insights shared from our 2023 State of the Market report to stay up-to-date with the latest healthcare trends and data.
View resourcePlaybooks
3 Steps to Building a Provider Network
This ebook identifies a 3-step process for successful network build, and offers an overview of Zelis Network Builder & Optimizer capabilities.
View resourceBlog
A look ahead to 2023 for health plans and TPAs
TPAs and health plans are facing significant headwinds when it comes to creating a modern healthcare network. So how do we move forward?
View resource