Provider Electronic Payments Frequently Asked Questions

Who is Zelis – Zelis harnesses data-driven insights and human expertise at scale to optimize every step of the healthcare payment cycle. We partner with more than 700 payers, including the top-5 national health plans, Blues plans, regional health plans, TPAs and self-insured employers, 1.5 million providers and millions of members, enabling the healthcare industry to pay for care, with care.

Why should we switch from paper payments to Zelis payments? – Moving from paper claim payments to electronic claim payments with Zelis allows you to improve cash flow, increase data accuracy, and gain on-demand online access to payment and remittance information from a consolidated network of 350+ payers. Further, speeding up the receipt of primary payment allows you to pursue secondary billing more quickly. Electronic payments post faster and eliminate time-consuming tasks such as endorsing checks, delivering them to the bank, and waiting for them to clear. Electronic remittance advice allows for easier reconciling and eliminates the need to re-key data into a practice management system.

How can Zelis improve the quality of my data? – Explanation of Payment (EOPs) can be downloaded directly from the Zelis portal in standard 835 or CSV format. Not having to re-key this data, which can potentially lead to keying and posting errors. Additionally, Zelis Payments’ unique integrations within Payer core systems allow us to pull data beyond “check level” data, which means the data is inclusive of all uniform Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), and Claim Adjustment Group Codes (CAGs) to generate detailed, accurate, balanced error-free remittance data.

How do I get started? – To enroll in electronic payments with Zelis call 1-855-496-1571 or click here to fill out the enrollment form and have an enrollment advisor reach out to you.

Will we need to modify anything in our practice management system? – No. When you enroll with Zelis you will be able to receive HIPAA 5010 835 or CSV files which may be imported directly into your practice management or health information systems with little or no modification. You also have the option of receiving PDF or paper EOPs as a batch, or you may receive any individual EOP via fax.

Will using electronic payments require my staff to have specific skill sets? – There are no special skills required to view electronic payment data via our easy-to-use online portal. Simple PC and Internet skills are all that are required.

Am I required to have electronic data interchange (EDI) capability? – No additional software and hardware are needed to access your payment and remittance platforms. You need only access the internet to receive remittance advice via the secure Zelis portal.

How is remittance data delivered? – You have a choice in how your remittance data is delivered. You can access remittance data through the Zelis provider portal to download your data in a format you select (EOP, 835, PDF, etc.) or you can receive data directly from your clearinghouse or from your FTPS servers. Any of these choices may be selected during enrollment and you may choose to change your delivery preference at any time.

How long will our records be stored? – Records are stored for 10 years. During this time, you may elect to download and archive records on your own systems if a longer retention period is required.

Is Zelis payments compliant with the 5010 835 standard? – Yes, Zelis is CAQH CORE III compliant.

Is Zelis payments HIPAA compliant? – Yes, Zelis is fully HIPAA compliant.

Can we maintain our existing banking relationships? – Yes, Zelis is designed to work with any financial institution. All account information is entered directly into the secure Zelis provider registration portal. Bank information is encrypted and only visible to you.