Zelis Helps Healthcare Payers Manage Rising Specialty Drug Cost

11:00 EDT 1 Aug 2017 | Businesswire
Zelis Healthcare

Zelis Healthcare announces the launch of the Zelis Specialty Drug Claims Cost Management Solution, another proprietary claims cost management innovation. Developed by the Zelis Specialty Clinical Audit Team, the solution supports healthcare payers with efficient and effective management of specialty drug claims prior to payment.

Zelis has deployed its proprietary Smart Logic claim selection technology and clinical algorithms, deep clinical audits and unique approach to episode of care management, to deliver immediate impact on the cost of specialty drug claims. The goal remains to provide payers with accurate and appropriate reimbursement.

Single claim submissions as well as members’ entire episodes of treatment are managed to ensure consistent outcomes, provide full transparency, and enable maximum claims savings.

“The rapidly rising cost of specialty drugs is on payers’, employers’ and consumers’ minds. It’s time for innovative solutions that help payers better understand and manage specialty drug spend. Medical claims that include specialty drugs and implants are often inaccurately coded, lack specificity of claim data, and are inadequately monitored. These claims pass through undetected, driving inappropriate and unnecessary claims cost. The Zelis Specialty Drug Claims Cost Management Solution is fully integrated with our Clinical Bill Review and Audit Solutions to enable immediate identification of specialty drug claims, recognition and storage of billing patterns and triggering of flags for unsubstantiated charges and related egregious costs,” said Lori Sempervive, President of Claims Integrity.

“This is an exciting time at Zelis Healthcare as we continue to pioneer disruptive network analytics, design and access solutions, claims cost management solutions, and electronic payments solutions for healthcare, dental and workers’ compensation payers nationwide. Our leadership team’s deep experience with leading PBMs, Specialty Drug PBMs and retail drug chains helped us understand the unmet need in the market for pre-payment specialty drug claims cost management and enabled us to develop a breakthrough solution that adds unique, immediate value for payers,” said Doug Klinger, CEO of Zelis Healthcare.

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About Zelis Healthcare

Zelis Healthcare is a healthcare information technology company and market-leading provider of end-to-end healthcare claims cost management and payments solutions. Zelis Healthcare focuses on network analytics and access, claims integrity and electronic payments for healthcare payers, providers and consumers in the medical, dental and workers’ compensation markets nationwide. Zelis Healthcare is backed by Parthenon Capital Partners.

Zelis Healthcare
Christina Haberle, 908-340-6852


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