Zelis

Pay for care, with care.

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Overview

Zelis focuses on optimizing healthcare payments and pricing. While primarily known for its payment integrity, network solutions, and claims cost management, it offers services that touch upon the pre-service stage, including member eligibility and navigating complex claims, which can involve authorization components. Their solutions are more payer-focused but impact the provider authorization workflow.

✨ Key Features

  • Payment Integrity
  • Claims Cost Management
  • Network Analytics and Optimization
  • Digital Payments
  • Member Eligibility

🎯 Key Differentiators

  • Focus on the intersection of payments, pricing, and claims
  • Strong payer-side solutions
  • Comprehensive platform for cost containment and payment optimization

Unique Value: Modernizes the business of healthcare by aligning the interests of payers, providers, and consumers to optimize the cost and process of payments.

🎯 Use Cases (3)

Payers managing claims costs and payment accuracy Optimizing provider networks Streamlining healthcare payments for all stakeholders

✅ Best For

  • Serving hundreds of payers and thousands of providers.

💡 Check With Vendor

Verify these considerations match your specific requirements:

  • Providers looking for a direct, front-end prior authorization submission tool

🏆 Alternatives

Change Healthcare (Optum) Waystar Cotiviti

Focuses more on the financial transaction and cost containment aspects of healthcare rather than the clinical workflow of prior authorization.

💻 Platforms

Web API

🔌 Integrations

Payer core administrative systems Provider practice management systems

🛟 Support Options

  • ✓ Email Support
  • ✓ Phone Support
  • ✓ Dedicated Support (Enterprise tier)

🔒 Compliance & Security

✓ SOC 2 ✓ HIPAA ✓ BAA Available ✓ ISO 27001 ✓ SSO ✓ HITRUST

💰 Pricing

Contact for pricing

Free tier: N/A

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