How Zelis Aims to Improve Efficiency in Healthcare Payments

How Zelis Aims to Improve Efficiency in Healthcare Payments

According to Research and Markets, the global healthcare finance solutions market size is anticipated to reach $216.4 billion by 2030, expanding at a compound annual growth rate (CAGR) of 7.8 percent from 2023 to 2030.

Zelis, an industry leader dedicated to modernizing the healthcare sector, is widely recognized for its platform designed to address gaps in the healthcare financial system. This platform provides solutions to healthcare networks, ensuring regulatory compliance, managing out-of-network costs and enhancing payment integrity.

Recently, the company unveiled its latest offering: In-Network Pricing and Contract Modeling. This new service empowers health plans with enhanced efficiency, accuracy and transparency to effectively manage costs, optimize networks and mitigate financial risks.

“We understand that navigating complex stakeholder relationships and evolving healthcare regulations requires more from a cost management partner than strictly managing cost,” said Jay Deady, Zelis’ president of Price Optimization, in the news release.

“Platform solutions like this compound efficiencies, enhance the member experience, minimize payer-provider abrasion and lower the overall cost of care for everyone involved,” added Deady.

RELATED: New Physician Salary 2024 Report Highlights Compensation, Overwork and Shortage

Reimaging Healthcare Finance: The Impact of Zelis’ Latest Innovation

Zelis’ new comprehensive and adaptable solution provides health plans with a transparent understanding of costs, enabling more precise pricing for contracted claims. Leveraging Zelis’ extensive library of pricing methodologies, health plans can price against any contracted rate, ensuring accuracy and efficiency. The suite of services includes:

  • Out-of-Network Pricing and Services: Featuring a dynamic optimization engine with customizable rules to efficiently route claims to the best savings channel.
  • Open Access Pricing: Offering a member-centric, reference-based pricing plan that establishes maximum reimbursement amounts through predefined prices, granting members greater autonomy over healthcare provider choices and expenses.

These customizable solutions create a controlled savings model and assist health plans in understanding and proactively managing claim pricing, processing and financial implications arising from contract adjustments.

Unlike competing solutions, Zelis’ In-Network Pricing and Contract Modeling solution minimizes friction between health plans and healthcare providers, effectively mitigating instances of balance billing for members. This unique capability fosters enhanced transparency and an improved experience for all involved parties.

Competitors in the Healthcare Payments Market

While Zelis continues to innovate, other industry leaders are also making strides in healthcare payments.

A subsidiary of J.P. Morgan, InstaMed impacts the healthcare payments landscape with its integrated platform connecting consumers, providers and payers. Using patented, private cloud-based technology, InstaMed securely facilitates electronic transactions, processes payments and seamlessly manages healthcare data, ultimately enhancing consumer satisfaction.

InstaMed’s all-encompassing platform streamlines eligibility, claims, remittance and payer payment transactions while optimizing the healthcare revenue cycle through advanced digital payment solutions. These innovations accelerate cash flow, boost staff efficiency and mitigate bad debt, delivering a superior healthcare payment experience.

R1 RCM is a prominent American company specializing in revenue cycle management (RCM) services for hospitals, health systems and physician groups nationwide. Renowned for its innovative technology-driven solutions, R1 transforms the patient experience and enhances the financial performance of healthcare providers.

Central to its offerings is the R1 Platform, which leverages AI, intelligent automation and deep data analytics to empower healthcare organizations. Through proprietary optimization engines, complex data is converted into tangible financial and operational enhancements, enabling healthcare institutions to deliver exceptional patient care. R1 provides a suite of revenue performance solutions designed to optimize, expedite and navigate revenue recovery processes.

R1’s RCM solutions cater to physician groups and specialty care practices across acute and non-acute care settings. These solutions are crafted to maximize reimbursements while minimizing costs and facilitating accelerated financial and operational improvements. By alleviating administrative burdens, R1 enables healthcare professionals to concentrate on delivering outstanding patient care.

To have your organization featured on Xtalks, please email Vera Kovacevic, PhD, at: [email protected]