As a Zelis client, you may have heard about our innovative approach to payments. These include a proprietary technology which integrates with leading adjudication platforms, a unique provider-focused approach to payment enrollment, award-winning service and value-added services designed to deliver increased efficiency to providers – including our award-winning and industry recognized Smart Routing solution.
But did you know that the payments business unit also employs in-house expertise and conducts ongoing programs which deliver additional value to our clients? These services are thoughtfully designed to address challenges and concerns and allow you to leverage Zelis’ expertise without making additional resource investments. This article pulls back the curtain to provide a behind the scenes glimpse at how Zelis’ commitment to “better processes” delivers “better results” to our payer clients.
Ongoing Quality Assurance (QA) Program
“Concerns about provider abrasion are a common denominator among all types of payers and plans, and it’s a particularly heightened concern when it comes to electronic transactions,” says Jay Ver Hulst, President of Zelis’ Payments business unit. “We understand the importance of the provider/plan and provider/payer relationship. The concept of handing over the care of your providers to a third-party may raise concerns. This is why we employ an in-house QA team to ensure we’re delivering the highest level of service. We believe we are the only payments partner who employs such a program.”
As part of Zelis’ QA program, all calls are recorded, and a percentage of calls are monitored and assessed daily. Service associates are measured against pre-established measurements which include etiquette, professionalism, active listening and other factors which contribute to an overall positive experience. Associates are held to rigid performance goals, and ongoing training and one-on-one coaching is regularly performed to reinforce Zelis’ standards and motivate associates to achieve excellence.
Proactive Program to Eliminate Stale Payments
When virtual cards are in a payer’s ePayment mix, there is always the possibility of unprocessed payments, which would result in “stale” payments on the books and create administrative headache for payers. To solve this problem, Zelis carefully monitors issued but un-processed cards and follows a three-step protocol. First, for providers that typically settle our virtual cards, our system will automatically re-send the virtual card and EOP after seven days of non-settlement. The fax is sent with a cover page notation reading: “This payment has already been sent … but you have not yet run the transaction.” This action alone helps to initiate a significant number of transactions without human intervention. Secondly, a team of associates are trained to conduct outreach to providers with unprocessed payments on a periodic basis to alert them to the unprocessed payment and encourage immediate settlement of the card. Lastly, an algorithm will detect potential “stale cards” that are not processed after thirty (30) days, so the card number may be cancelled, and a check is issued.
Regulatory Guidance and Support
Zelis employs an in-house legislative affairs expert, Matthew Albright, to address regulatory concerns for all Zelis business lines. Albright brings a caliber of expertise and talent which significantly benefits all Zelis clients and is particularly well-suited to tackle ongoing regulation and legislative initiatives in the payments industry.
As a former legislative executive from the Centers for Medicare & Medicaid Services, Albright was one of the chief authors of the regulations that implemented Section 1104 of the Patient Protection and Affordable Care Act, which mandates operating rules for the HIPAA-mandated transaction standards including electronic payments and remittance transmittals. He additionally held an executive position at the Center for Affordable Quality Healthcare Committee on Operating Rules for Information Exchange which is the authoring entity for all section 1104 operating rules. Albright continually monitors ongoing regulatory issues, tracks legislation at the national and state level and provides client updates as major developments occur.
By leveraging this in-house expertise, Zelis has also been able to help influence legislative efforts as they are in process. One instance of this type of involvement occurred earlier this year, when a bill was introduced in a large state, which implied that a provider would have to submit written documentation to “opt-out” of any payment. Zelis felt this version of the bill was bad for the industry because it would have created a negative experience for providers and subsequent negative effects for payers and payment vendors. Albright interceded and drafted language for the bill that would better protect the interests of all stakeholders.
“Since our inception, we strive to be the leader in healthcare payments through continuous innovation and responsiveness to client needs,” says Ver Hulst. “Very often these needs go unspoken since many payers have only experienced standard payment services. As such, there’s an assumption that a payment solution should only do one thing: reduce check and postage costs. When we tell prospective clients about our added services, we’re always delighted to hear, ‘Wow! You do that?’ It inspires us to continually ‘raise the bar’ in the industry.”
This article highlights just a few of Zelis’ value added services. To learn more about the value-added services that are part of our payments offering, download the overview.