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Provider Search: Transparency in Coverage

Provider Search offers improved member search calls through expertly curated data that is compliant with the Transparency in Coverage (TiC) mandate. Enhanced calls supply members with cost-sharing liability, including negotiated in-network rates, accumulations, prerequisites (prior authorization), benefit limits, out-of-network cost details, and cost-sharing information based on place of service. Members run inquiries based on a procedure’s billing code or by entering a short description.

Zelis data drives Provider Search. Clients incorporating this data into their platforms deliver relevant information returned with search calls that is also TiC compliant.

API Overview

TiC conformity and more

Compliance in the healthcare financial space is a dynamic and ever-moving goal. Zelis eases this friction with regularly updated data assets that adhere to TiC regulations. The Provider Search API accesses data that meets TiC compliance guidelines. Search results can include data regarding member’s cost sharing liability including negotiated in-network rates, accumulations, prerequisites (prior authorization), benefit limits, out-of-network cost details, and cost sharing information based on location (place of service). Elevate member search calls with detailed cost information that also adheres to regulatory mandates.

What to Expect

Why Zelis?

Zelis modernizes healthcare financial experiences through data-driven technology, and our APIs simplify everyday healthcare experiences for your members. The Provider Search API gives your members TiC-compliant cost estimates based on their unique search inquiries.

Advantages Breakdown

  • Transparency in Coverage compliant data sets
  • Data expertly curated by Zelis specialists
  • Calls made with billing code or short description for ease of use
  • Configurable data based on client needs
Use Case

Compliant Provider Searches

Learn how Zelis’s Provider Search API can offer your members cost-estimate searches fully compliant with TiC regulations.

View use case

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