Provider Decision Support
Managing data for a smoother provider search experience.
Create custom provider search solutions with ease.
With multiple data sources and conflicting information, building a robust provider search can be a time-consuming process. Zelis takes a multi-layered approach to deliver the fastest, most reliable provider search solution for your network.
Built for benefit administrators, consultants, brokers, healthcare IT partners and exchanges, Zelis’ Provider Nexus cleans, organizes and standardizes the best available data from multiple carriers to put the most reliable provider information within your reach.
This nationwide provider database is just the tip of the iceberg. Using our highly configurable Provider Nexus API, your developers can seamlessly integrate search queries (endpoints) and results into your platform. You can filter by your own attributes, including premium designations, centers of excellence, enrollment codes and PCP IDs.
Provider Nexus is only possible because our partners – both our clients and carriers – trust us to protect and maintain the integrity of the provider data, while using it to deliver the best possible service.
Consolidated Provider Database
We support the full spectrum of direct carrier data sources including commercial, Medicare, exchange, vision, dental, and behavioral health.
Filter and standardize data based on matching identifiers, geographic proximity, specialties and common name patterns.
Try before you buy, with a 30-day test to ensure Provider Nexus achieves your goals before you invest a single penny in our solution.
Configurable API Implementation & Documentation Library
Our agile API adjusts to your workflow, delivering exactly the variables your developers need supported by our comprehensive documentation written by developers for developers.
Spot application errors before they cause disruptions in service with constant, automated API monitoring.
Work directly with data experts from Zelis to track down and collaborate with carrier data teams to correct data problems ASAP.
API Documentation Library
A comprehensive documentation written by developers for developers.
Get an inside look at the market.
Market360 is a ready-to-go provider network dataset covering the vast majority of national and regional payers. This Zelis network-tagged provider data has healthcare IT, health plan consultants, brokers, and research companies covered for individual and family, small, mid- and large-group, Medicare, Medicaid and dental network providers.
For benefit administrators, consultants and brokers, healthcare IT partners and exchanges
Provider Nexus can help you:
Provider Decision Support in action.
“One benefit of working with Zelis is their flexibility to meet our ever-changing needs. Our TPA is geographically located in a very demanding “provider hotbed” so we experience excessive pushback and nonconformity. Zelis continues to put forward unique options and opportunities to allow collaborative efforts to manage the high cost of services in our member’s complex medical care market.”
– Cindy, COO of TPA
“As a regional health plan, we face challenges with serving our local communities and having an understanding of what is happening on a national level. Working with Zelis helps us tackle that problem. They have knowledge beyond our region, and they help bring that information to us so that we can make smarter strategic decisions.”
– Todd, Manager at Regional Health Plan
“Zelis has great network access and their analytics team is awesome. One of our clients was requesting unique reporting, and they delivered exactly what we needed, and quickly. I would definitely recommend Zelis. We’re a small company, but we’re always treated like we‘re their biggest client.”
– Jeannie, Provider Consultant for Regional Health Plan