TiC Compliant Data
Zelis provides API consumers fully compliant data sets to ensure regulatory adherence
Custom Search Calls for Member Needs
As a systems developer for a health insurance provider, Chris regularly oversaw the implementation of innovative programs and applications on the company’s member portal.
Sometimes, the new systems created unexpected changes in the daily operations of some departments, and Chris had to work with department managers to find solutions.
Today, Raquel, a member services manager, sat in Chris’ office concerned.
“I’ve noticed a substantial decline in member call activity in the last six months. What’s odd is the drop is most significant in charge disputes.”
Chris joked, “That’s a good thing, isn’t it?”
Raquel chuckled and nodded before adding, “But why primarily that type of call?”
Chris tried to recount quickly all the system upgrades that occurred in the last year before excitedly answering.
“Oh, right! That’s because of Provider Search!”
Why It Matters
Compliance plus member peace of mind
“Provider Search is an API enhancement of our platform’s search database,” Chris explained.
“Along with searching for providers or facilities, members can also search for pricing by their cost share liability. Provider Search will return personalized costs to members, all based on their coverage. It also helps keep us in compliance with the TiC mandate.”
The concern instantly dropped from Raquel’s face, replaced instead with relief.
“Members are getting procedure-specific pricing through our portal and not getting surprised by the billing later.”
Chris leaned back in his chair before adding, “This means fewer upset members are calling your department, and we stay federally compliant.”
Use Case Featured APIs
- Provider Search: Transparency in Coverage
Zelis APIs
Optimized search data
The Provider Search API offers TiC compliant data that API consumers can utilize to bolster member experiences while streamlining business operations. Stay compliant while enhancing search functionality through data maintained by Zelis specialists.
Optimized and compliant data solutions
In the ever-changing healthcare financial space, Zelis offers stability through vetted, accurate, and legally compliant data. Zelis data experts maintain and update the resources powering API products like Provider Search. This effort ensures Provider Search data meets regulations like the Transparency in Coverage mandate. Provider Search offers compliant data to enhance platform functionality and boost member satisfaction.
Why Zelis?
Zelis enables users
We are more than data specialists. Zelis’ innovative catalog of APIs bolsters platforms with intelligent technologies designed to reduce friction in the healthcare financial space. Read on to learn how to leverage Zelis innovation to boost your platform’s performance.
Other Use Cases
Leading by example
Use Case
Provider Search
Brian learns the benefits of using Provider Search to locate a provider that also meets other specific metrics important to Brian.
View Use Case