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 with Transparency in Coverage!“
Why It Matters
Compliance plus member peace of mind
“Provider Search with TiC 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 with TiC will return personalized costs to members, all based on their coverage. It also helps keep us in compliance with the Transparency in Coverage 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 with TiC API offers TiC-compliant data, making it convenient for API consumers to enhance member experiences and streamline business operations. But that is only part of what Provider Search with TiC can do.
API consumers can also opt for Provider Search with TiC’s Quality Data license enhancement, which delivers quality information for member provider searches. With the Quality Data add-on, searches for facilities and providers return a quality score plus other relevant information. Such scores can be used to allow members to sort and prioritize options based on quality metrics and costs. With those tools, members can make informed healthcare decisions that suit their needs.
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 with TiC. Provider Search offers compliant data to enhance platform functionality and boost member satisfaction.
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.
