Zelis Payments
Zelis Payments is a US-based healthcare financial technology company operating a unified platform spanning network management, claims pricing, payment integrity, payment delivery, and member engagement for over 770 payer clients and provider organizations across the United States.
- Company typePrivate
- Founded2016
- HeadquartersClearwater, United States
- Headcount101–250
- GTM typeB2B
- OfferingSoftware
What Zelis Payments does
Zelis Payments (legal entity Zelis Healthcare) is a US-based healthcare financial technology company that operates a unified platform spanning the entire healthcare financial journey, from network design through claims pricing, payment integrity, payment delivery, and member engagement. The company serves more than 770 payer clients and works on behalf of more than 725 insurers nationwide, targeting health plans, third-party administrators, property and casualty payers, brokers and benefit consultants, and dental payers, as well as provider organizations including health systems, hospitals, medical practices, and dental practices.
The platform architecture centers on the Zelis Intelligent Pricing Platform℠, which integrates payment integrity and claims pricing into a single system, and is complemented by five core solution areas: Network Solutions (anchored by Network360®), Member Engagement (S365, SmartShopper, and decision-support tools), Payment Integrity (claims editing, bill review, claims negotiations), Payments + Communications via ZAPP, and Price Transparency/TiC compliance offerings. Supporting modules include reference-based pricing, out-of-network solutions, No Surprises Act compliance with an AI-native IDR solution, and an API Marketplace for third-party integrations.
Zelis operates an enterprise B2B go-to-market with direct field sales, solution advisors, and consultative engagement targeting large healthcare organizations. Pricing is quote-based and not publicly disclosed, with revenue derived from recurring platform fees and transaction-based payment services. The company has expanded operational footprint into India, evidenced by India-specific Great Place to Work 2026 recognition and ISO 27001 certification alongside US equivalents. The firm is privately held, headquartered in Clearwater, Florida, and recognized with a 2026 MedTech Award.
Zelis Payments firmographics
Firmographics- Name
- Zelis Payments
- Legal name
- Zelis Healthcare
- Website
- https://zelispayments.com
- Company type
- Private
- Founded year
- 2016
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Zelis Payments is a US-based healthcare financial technology company operating a unified platform spanning network management, claims pricing, payment integrity, payment delivery, and member engagement for over 770 payer clients and provider organizations across the United States.
- Ownership category
- akta.pro rank
Zelis Payments industry classification
Industry- Product category
- Healthcare Payments Technology
- NAICS
- Financial Transactions Processing, Reserve, and Clearinghouse Activities (52232), Custom Computer Programming Services (541511)
- SIC
- Services-Computer Programming, Data Processing, Etc. (7370)
- akta.pro primary industry
- Patient Billing, Statements & Payment Processing (HLACACAG)
- akta.pro secondary industries
- Price Transparency, Estimates & Patient Financial Clearance (HLACACAK), Payer-Provider Data Exchange (X12, prior auth, claims/clinical attachment) (HLACABAK), Eligibility & Benefits Verification (HLACACAD)
Keywords
Where Zelis Payments is headquartered
LocationHeadquarters
- HQ city
- Clearwater
- HQ country
- United States
- HQ region
- North America
Markets served
Zelis Payments business model
Business model- GTM type
- B2B
- Offering type
- Software
- Cost components
- Technology or R&D, Personnel, Operations, Marketing or Sales, Infrastructure
Revenue model
- Healthcare Financial Technology Solutions: Zelis generates revenue by providing a suite of integrated healthcare financial solutions to payers and providers, including network solutions, claims pricing, payment integrity, and member engagement. The company operates on enterprise contracts with payer clients (health plans, TPAs) and provider organizations, likely through recurring platform and service fees.
Go-to-market motion1 record
Distribution channels1 record
Marketing channels12 records
Zelis Payments product offering
Product offeringCore offering
Zelis Payments operates a purpose-built healthcare financial technology platform that prices, pays, and empowers the healthcare financial experience for payers, providers, and members. Its core offering centers on the Zelis Intelligent Pricing Platform℠, integrating payment integrity, claims pricing, network management, payment delivery via ZAPP, and member engagement capabilities (including SmartShopper, S365, Network360®) to reduce costs and administrative burden for more than 770 payer clients and 725+ insurers in the US market. Revenue is generated through enterprise B2B contracts covering software platforms and associated services such as claims editing, bill review, claims negotiations, reference-based pricing, and No Surprises Act compliance support including an AI-native IDR solution.
Product overview
Zelis Payments offers a unified platform-plus-modules architecture centered on the Zelis Intelligent Pricing Platform℠. The core platform integrates payment integrity and claims pricing capabilities, supported by five interconnected solution areas: Network Solutions (for building and managing provider networks), Member Engagement (for benefits enrollment, cost transparency, and provider search), Payment Integrity (for claims editing, bill review, and pricing accuracy), Payments + Communications via ZAPP (for payment delivery and member communications), and Price Transparency + TiC compliance tools. Additional modules include claims editing, bill review, claims negotiations, open access/reference-based pricing, provider decision support, SmartShopper, S365, Network360®, and an API Marketplace. The No Surprises Act compliance module provides defensible pricing and IDR support. The platform serves more than 770 payers and processes payments to numerous providers nationwide.
Differentiator
Problem solved
Functional benefit
Brands
- ZAPP: Payments platform for delivering faster payments and better communications to clients.
- Network360
- Zelis Intelligent Pricing Platform
- SmartShopper
- S365
Products and services
- Zelis Intelligent Pricing Platform℠ Unified core platform that integrates payment integrity and claims pricing capabilities to optimize every claim, spanning the entire financial journey from network building to payment delivery. Designed for healthcare payers seeking a consolidated technology foundation.
- Network Solutions Standalone solution for building, maintaining, and optimizing competitive, high-performing provider networks through design, assessment, and maintenance of optimal care networks, aimed at health plans, TPAs, and dental payers.
- Member Engagement Standalone solution that engages and incentivizes members to enroll in, access, and utilize their benefits, offering enrollment tools, ID cards, cost transparency tools, provider search, and personalized support for payer organizations.
- Payment Integrity Standalone solution combining claims editing, bill review, and claims negotiations to capture savings on every claim before payment, ensuring accuracy and reducing costs for payers.
- Payments + Communications (ZAPP) Standalone ZAPP platform enabling secure delivery of cash flow and payment data to providers, easier collection of premium payments, and clear member communications about how benefits were applied and paid.
- Price Transparency + TiC Standalone, customizable price transparency solution enabling payers to stay compliant with Transparency in Coverage (TiC) regulatory requirements.
- Out-of-Network Solutions Standalone solution using a layered approach to out-of-network claims management, including negotiations and defensible pricing, designed to uncover significant savings for payers.
- Reference-Based Pricing Standalone reference-based pricing solution that enables open access pricing and network replacement to set limits on rising healthcare costs while empowering members.
- In-Network Pricing Standalone solution automating claims pricing and strengthening provider contracting negotiations with data-driven pricing tools for health plan payer organizations.
- No Surprises Act Compliance Standalone compliance solution that helps payers achieve No Surprises Act compliance through defensible pricing, post-payment support, and an AI-native Independent Dispute Resolution (IDR) capability launched in 2026.
- API Marketplace Standalone marketplace providing access to Zelis API capabilities and third-party integrations, enabling developers and partners to extend the Zelis platform.
- Provider Payments Standalone provider-facing offering enabling healthcare providers to receive timely payments and payment data from payers with secure delivery.
Quantifiable outcome
- Billions in savings for payer clients over long-term partnerships
- +1 more outcomes
Companies that use Zelis Payments
Customer profileNamed customers3 records
Segments3 records
Ideal customer profiles2 records
Zelis Payments technology and API
TechnologyTechnology focussed Yes
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
AI capability3 records
Feature11 records
Zelis Payments partnerships and signals
Strategic signalScale indicators3 records
Recent moves6 records
Expansion highlights6 records
Zelis Payments competitors and assessment
Company assessmentDirect peers
- Cotiviti: Cotiviti is a direct competitor in payment integrity, claims editing, and payment accuracy for healthcare payers. Both companies compete for the same health plan and TPA buyers with overlapping claims pricing and overpayment-recovery capabilities.
- Availity: Availity is a direct peer in payer-provider data exchange, eligibility, and clinical attachment workflows. Both companies serve health plans and providers with API-driven interoperability and EDI connectivity, overlapping in the same buyer base.
- Waystar: Waystar is a direct peer in healthcare payments and revenue cycle technology for providers and payers. Its payment processing, claims management, and patient engagement capabilities directly overlap with ZAPP, Claims Editing, and Price Transparency offerings.
- HealthEdge: HealthEdge provides core administrative processing, payment integrity, and member engagement software to health plans. It competes for the same payer buyer as Zelis, particularly in claims pricing, payment accuracy, and member engagement.
- Edifecs: Edifecs is a peer in payer-provider interoperability, X12 EDI, and value-based care data exchange. It overlaps with Zelis's API Marketplace and payer-provider data exchange capabilities, serving similar health plan and TPA customers.
- Claim.MD: Claim.MD is a direct peer in healthcare claims processing and clearinghouse services, handling EDI transactions and payment routing for payers and providers. It competes in the same operational layer as Zelis's claims and payment delivery stack.
Broad incumbents
- Optum (UnitedHealth Group): Optum is a broad incumbent that, post-Change Healthcare, offers end-to-end healthcare payments, RCM, and data exchange capabilities to payers and providers. It competes with Zelis across payment integrity, claims processing, and payer-provider data exchange, but as part of a much larger portfolio.
- InstaMed (J.P. Morgan): InstaMed, now part of J.P. Morgan, is a broad incumbent in healthcare payments, connecting payers, providers, and members. It competes with ZAPP and Zelis's provider payment and member communication offerings from a much larger financial-services platform.
- Conduent: Conduent is a broad incumbent in healthcare payment integrity, claims processing, and member engagement services for payers and government programs. It competes with Zelis across payment accuracy, eligibility, and member communications as part of a larger BPO portfolio.
Emerging players
- Omega Healthcare: Omega Healthcare is an emerging player in RCM, payment integrity, and back-office healthcare operations. It overlaps with Zelis's claims editing and bill review capabilities, often serving as a services-led complement or competitor to technology-first platforms.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat6 records
Key risks6 records
Key highlights7 records
Customer concentration
Zelis Payments social profiles
Digital presenceZelis Payments financial estimates
Financial estimateRevenue estimate
Valuation estimate
Zelis Payments leadership team
Management profileNumber of profiles
Zelis Payments funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Zelis Payments M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Zelis Payments
What does Zelis Payments do?
Zelis Payments operates a purpose-built healthcare financial technology platform that prices, pays, and empowers the healthcare financial experience for payers, providers, and members. Its core offering centers on the Zelis Intelligent Pricing Platform℠, integrating payment integrity, claims pricing, network management, payment delivery via ZAPP, and member engagement capabilities (including SmartShopper, S365, Network360®) to reduce costs and administrative burden for more than 770 payer clients and 725+ insurers in the US market. Revenue is generated through enterprise B2B contracts covering software platforms and associated services such as claims editing, bill review, claims negotiations, reference-based pricing, and No Surprises Act compliance support including an AI-native IDR solution.
Is Zelis Payments a public or private company?
Zelis Payments is a private company. It is classified as unknown and is currently operating.
When was Zelis Payments founded?
Zelis Payments was founded in 2016. It employs 101 to 250 people.
Where is Zelis Payments based?
Zelis Payments is headquartered in Clearwater, United States, in the North America region.
How does Zelis Payments make money?
One revenue line is on record: healthcare Financial Technology Solutions.
Who are Zelis Payments's main competitors?
Direct peers on record are Cotiviti, Availity, Waystar, HealthEdge, Edifecs and Claim.MD. Broad incumbents are Optum (UnitedHealth Group), InstaMed (J.P. Morgan) and Conduent. Omega Healthcare is listed as an emerging player.
Does Zelis Payments have an API?
No public API is recorded for Zelis Payments.
What industry is Zelis Payments in?
Zelis Payments's product category is Healthcare Payments Technology. Its primary akta.pro industry code is HLACACAG, Patient Billing, Statements & Payment Processing, with a secondary code of HLACACAK, Price Transparency, Estimates & Patient Financial Clearance. Its NAICS code is 52232 and its SIC code is 7370.