In⁤ the complex world‌ of healthcare finance, trust and openness ‌between payers and providers‍ are often elusive. But for one Arizona-based integrated delivery network (IDN), partnering ⁢with Zelis-a leading provider of ​healthcare technology solutions-marked a turning point. By implementing Zelis’ Advanced payments ​Platform (ZAPP), the IDN ⁣transformed a fragmented, paper-dependent payment system⁢ into a streamlined digital ecosystem, saving time,​ cutting costs, and strengthening payer-provider relationships.

Recently recognized with a KLAS ‍Points of⁣ Light Award on August ‍15, 2024, the initiative offers a blueprint for how healthcare organizations can ⁤unify ⁢financial workflows and foster collaboration at⁢ scale.

Fragmentation and ‍Friction with Outdated Systems

The IDN faced meaningful‍ challenges with a payment system reliant on ​manual processes. Paper checks were commonplace, ‌leading to⁤ payment delays of up to 60 days, increased⁢ fraud risk, and significant administrative costs.The lack of real-time data exchange⁢ between multiple⁤ payers and providers created friction, eroded trust, and made reconciliation a costly and inaccurate‌ process.

According to a⁣ McKinsey report, ‍administrative costs account ⁣for 25% of total US ​healthcare‌ spending. Modernizing payment systems is crucial for ⁣reducing⁢ these costs and improving​ efficiency.

Specifically, the IDN struggled with:

• Slow Payment Cycles: ⁣ Up to 60-day delays in receiving ⁢payments.
• High Administrative ⁣Burden: ‌ Significant ‌staff time dedicated to manual processing​ of⁣ paper checks and reconciliation.
• Increased Fraud Risk: Paper-based⁤ systems are more vulnerable to fraud and⁣ errors.
• Lack of Transparency: Difficulty tracking payment status and resolving discrepancies.

Zelis’ Advanced Payments Platform⁣ (ZAPP) to the Rescue

Zelis’ Advanced Payments Platform (ZAPP) ⁣provided a solution by automating and digitizing the IDN’s payment processes.‍ ZAPP integrates with⁢ multiple payers and providers,enabling real-time data exchange,automated reconciliation,and faster payment cycles.

Key features of ZAPP include:

• Automated ERA/EFT processing: ⁢ electronic⁤ Remittance Advice (ERA) and‍ Electronic ‍Funds ⁣Transfer (EFT) streamline payment posting and reconciliation.
• Real-Time ​Payment Visibility: ‌ ‌Providers can track payment status in real-time,‌ reducing ⁢inquiries and improving cash flow.
• fraud Detection and Prevention: Advanced analytics ⁤identify and prevent fraudulent ⁣claims.
• Denial Management: Automated denial management ‌tools help providers resolve​ claim denials quickly and efficiently.

With 80% of payments now digital, the IDN is aiming for full adoption. ‍Zelis continues ‍to ​refine its platform, integrating ⁤AI-driven ⁣analytics and expanding its payer⁢ network to ⁣support broader collaboration.