With an expanded Price Optimization suite of new end-to-end solutions, Zelis is continuing to innovate and expand its industry-leading Pricing and Payment Integrity solutions

BOSTON: Zelis, a leading provider of healthcare technology solutions, today announced that its Payment Integrity solutions received the top honor for Payment Accuracy & Integrity Solutions (Payer) segment in the 2024 Best in KLAS Awards – Software and Services. The annual ranking recognizes software and services companies that excel in helping healthcare professionals improve patient care.

This recognition follows KLAS’s inaugural report for payers, Payment Accuracy & Integrity Solutions 2023, which identified Zelis Payment Integrity as a top overall performer based on client ratings. Zelis received an overall performance score of 93.9 out of 100, outpacing the seven other companies surveyed in the payment integrity space. 100% of payer clients interviewed shared that Zelis is an integral part of their long-term plans, and indicated they would choose Zelis again without hesitation.

“To be rated by our payer clients and earn the Best in KLAS designation in payment integrity is particularly meaningful to our organization, recognizing the investment in these solution areas and account management, as well as the overall commitment that Zelis has made to modernize the healthcare financial experience,” said Jay Deady, President of Price Optimization at Zelis. “We have invested in building a payment integrity solutions suite that combines advanced technology, a highly-engaging partnership model, and superior service from our team of industry experts – a truly differentiated client experience for payers.”

Evolving market conditions in healthcare have led to a rise in claims costs, more billing complexities, and an increase in economic pressure for payers to find savings. Zelis’ Payment Integrity solutions are designed to address these headwinds – leveraging more than two decades of experience and a suite of services to help health plans improve payment and reimbursement accuracy. By identifying claims errors both pre- and post-payment, Zelis is reducing administrative waste and payer-provider abrasion, resulting in more than one billion dollars in annual savings for the healthcare system.

Zelis is enhancing its suite of end-to-end Payment Integrity solutions. Claims Editing leverages advanced technologies for customizable claims editing services that ensure alignment with medical and payment policies and contracts, CMS and other sources – identifying coding errors that can lead to billing and payment inaccuracies. Expert Claims Review offers full-scope clinical and financial analysis from a combination of advanced technology and a team of physicians, nurses and coders – providing a more in-depth review of high-dollar claims at risk for billing compliance and payment integrity issues.

More specifically, the Expert Claims Review suite has recently launched several new products:

• Diagnostic-Related Groups (DRG) Review & Validation, which reviews MS-DRG and APR-DRG claims and yields an average savings rate of 1-3% of associated DRG spend.

• Dialysis Savings Solution, which has an average savings rate of 90-95% on outpatient dialysis claims.
• Post-Pay Claims Review to ensure a fully integrated end-to-end solution so payer clients have the ability to review all claims where it fits into their workflows.

“The U.S. spends more than $4 trillion annually on healthcare, with administrative spend representing a quarter of that; market inflation continues and fraud and abuse is also on the rise,” said Deady. “Insurers are fighting competing priorities – looking to provide access to quality care at a reasonable price, while also navigating system-wide economic pressures and evolving regulations. Zelis is partnering with clients to remove complexities from claim review and provide savings that can be reinvested in better consumer experiences – a win-win for the healthcare system.”

For more information about Zelis’ suite of end-to-end Payment Integrity solutions, click here.

About Zelis

Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 700 payers, including the top 5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. Learn more at Zelis.com and follow us on LinkedIn to get the latest news.

About KLAS:

KLAS is a research and insights firm on a global mission to improve healthcare. Working with thousands of healthcare professionals and clinicians, KLAS gathers data and insights on software and services to deliver timely reports and performance data that represent provider and payer voices and act as catalysts for improving vendor performance. The KLAS research team publishes reports covering the most pressing questions facing healthcare technology today, including emerging technology insights, that provide early insights on the future of healthcare technology solutions. KLAS also fosters measurement and collaboration between healthcare providers and payers and best practice adoption. Learn more at klasresearch.com.

Fonte: Business Wire