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

TheProvider Search APIoffers 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 likeProvider Search. This effort ensuresProvider Searchdata meets regulations like the Transparency in Coverage mandate. Provider Search offers compliant data to enhance platform functionality and boost member satisfaction.

API Solutions

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.

Why Zelis?

Efficiency Exemplified

Tic Compliant Data

Zelis provides API consumers fully compliant data sets to ensure regulatory adherence

Custom Configuration

Clients can customize their data for specific business needs

Member-Specific Pricing

Offer members robust search functionalities that return pricing specific to the members coverage and desired procedures

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