Frequently Asked Questions

Find answers and general information quickly about working with Zelis Payments. Can’t find what you’re looking for here? Contact us at 877.828.8770.

  • About Zelis Payments

    What distinguishes Zelis Payments?

    Zelis Payments provides you access to an aggregated pool of payers representing the self-insured market. As the preferred vendor for these, Zelis Payments simplifies the delivery of payment and data – replacing paper-based payments and remittances into a streamlined electronic process, which eliminates manual processes, consolidates data, and reduces overhead expenses.

    Zelis Payments simplifies the delivery of payments and data, by enabling a provider to manage multiple payers or multiple groups who may represent multiple payers, through a single relationship with Zelis Payments. Additionally, Zelis Payments has the ability to deliver payments directly to the provider who submitted the claim. By working with you to build a routing scheme, we are able to route settlement of funds electronically at preferred levels within your health system by TIN, NPI, or a combination of TIN with NPI carve-outs. Our automated delivery system to your preferred location within your organization creates greater efficiency.

    Which payers are represented by Zelis Payments solutions?

    At Zelis Payments Solutions, we represent hundreds of payers, and the list of payers who use us is always growing. To find out if your payers impact your facility specifically, please call our Membership Sales Team at 877-828-8834.

    Is there a fee for your service?

    Zelis Payments provides a single relationship to manage payments and data connections from small healthcare payers (including Taft-Hartley, TPAs, and regional plans), which may represent hundreds of payer groups that require individual data/banking connections. These multiple payment and data connections are managed for a low fee. One of our representatives would be glad to discuss pricing with you.

    How will the quality of Zelis Payments’ 835s impact my revenue cycle?

    Zelis Payments’ data integration feeds with our adjudication partners, allowing us to extract accurate and balanced 835 data directly from the payer’s core administrative system. This provides detail that goes beyond “check-level” data to help providers to quickly reconcile claims to the penny.

    The detail of Zelis Payments’ 835s will enable you to conduct robust data analytics to improve the quality of the claims by comparing actual vs. expected reimbursement in a claim, and then analyzing the denial codes by payer to identify common denials. Such knowledge can improve the quality claims and reduce future denials.

    Additionally, the speed with which Zelis Payments delivers your payment and remittance data, will allow you to start patient and secondary billing up to 11 days sooner thus providing direct impact to your accounts receivable.

  • Getting Started: Implementation Process

    What is involved in activating my VRA account?

    When you are ready to move forward with a VRA account, a legal agreement will be provided to you to be signed. This document will outline the costs, product, and any agreed upon information specific to your account.

    Your assigned project manager will work with you throughout the entire process of implementation and go-live. They will ensure you have an efficient and streamlined model and will meet your agreed upon go-live date. The Zelis Payments project manager will ensure all teams are aligned, deliverables documented and communicated, and goals exceeded. Your project manager will monitor live transactions for 30 days to ensure consistent delivery.

    Will I receive implementation assistance?

    Zelis Payments provides larger health systems with an assigned project manager to ensure the efficient implementation of our payment system. Your project manager will work with your team throughout implementation to your agreed upon date of completion.  Projects can vary in complexity based on routing and mapping needs of each health system.

    Zelis Payments can route payments and remittance advice to specific remit to addresses.

    What type of ongoing support is provided?

    In addition to answering any questions regarding payments or assistance with our portal, Zelis Payments monitors your payments to ensure they are processed in a timely manner and watches for any suspicious or potentially fraudulent activity. Should an issue arise, we will alert you and work with you to achieve a satisfactory resolution. Our client support team is here to assist you with processing and testing of data files.

  • Receiving and Obtaining 835S

    How will I receive 835s?

    You will receive your 835 via the delivery method that works best for you. Your options are direct download from our secure server, secure email, FTPs, and Clearinghouse.

    What is the secure online provider portal?

    Zelis Payments offers a secure online provider portal for payments and data. With our online portal, access to your payment history is right at your fingertips! The provider portal is a secure gateway that provides access to up to seven (7) years of payment data.

    The website is easy to use and enables providers to use the information most effectively to meet their individual needs. Payment and remittance information can easily be viewed, printed, downloaded, and searched. Payments are settled into your bank account as an ACH with an addenda record (called a CCD+) which contains a Trace Re-Association Number (TRN). The TRN corresponds to the trace number in the 835 so that once both the bank data and 835 data are uploaded into your health information system they may be automatically settled. Likewise, printed EOPs may also be matched to your bank data using the same re-association number.

    We already receive payments from clearinghouses and CMS. Can you combine your files with files we currently receive from our clearinghouse?

    Unfortunately, this cannot be done. However, we can pass data to your preferred clearinghouse if you wish. This option may be selected during the enrollment process.

    How do I reload or see data again?

    Simply log into the web portal and download the electronic file. You may view any EOP in a PDF format, print individually, or batch locally on your printer.

    Is this system compatible with our hospital information system?

    Yes, as a Zelis Payments member, you will be able to receive HIPAA 5010 835 or CSV files which may be imported directly into your hospital information systems. You also have the option of receiving PDF or paper EOPs as a batch, or you may receive any individual EOP via fax.

    Will Zelis work with my billing company?

    Yes, Zelis Payments is happy to work with any and all billing companies as required by the client.

    How long will our records be stored?

    Records are stored for seven (7) years. During this time, you may elect to download and archive records on your own systems if a longer retention period is required.

  • Banking

    Can we maintain our existing banking relationships?

    Yes, Zelis Payments is designed to work with any financial institution. All account information is entered directly into our secure Provider Registration Portal. Bank information is encrypted and only visible to you.

    How do I change bank accounts/switch banks?

    Zelis Payments makes it easy to manage your banking relationships without the challenge of notifying all of your claims payers. Bank account information may only be accessed by those designated within your organization with authority to work in the Zelis Payments system. Updating your banking information through our web portal automatically updates all payments to you from all of our payer entities.

    How many financial institutions do you work with nationally?

    Zelis Payments moves all funds via our strategic banking partner, UMB Bank, NA. Through UMB, and the Federal Reserve, we have connections to all banking institutions without exception.

  • Standards & Security

    Is Zelis Payments compliant with the 5010 835 standard?

    Yes, Zelis Payments met CORE Phase III compliance in December of 2013.

    Is Zelis Payments HIPAA compliant?

    Yes, Zelis Payments is fully HIPAA compliant.

    How secure is my data?

    The Zelis Payments system data is encrypted at the server level. We are fully HIPAA security compliant.

    Who will have access to my financial information?

    Only Zelis Payments and those who you designate within your practice will have access to information stored within your portal account.  Since Zelis Payments makes payments on behalf of payers, your bank information remains securely with us and is never shared with payers.

    How do you ensure that my financial information is secure?

    All financial information is maintained in our secure database. Your information will not be forwarded, shared, or provided to any other organization at any time. Additionally, your financial information is not viewable to Zelis associates other than those approved to manage your account.

    External users can only access banking information if the designated administrator for the health system approves and entitles a user to have access to that specific screen within the password protected portal.

  • About Going Electronic

    Why would we want to switch from paper payments to Zelis Payments?

    Removing paper from the claim settlement process will allow you, as a provider, to improve cash flow by as much as eleven days, reduce settlement expenses, and gain increased access to payment and remittance information. Easy management of processing and routing of funds and data will improve your systems efficiency. Further, speeding up the receipt of the primary payment allows you to pursue patient and secondary billing more quickly. Electronic payments post faster and eliminate time-consuming tasks such as endorsing checks, delivering them to the bank, and waiting for them to clear. It also eliminates the relevant overhead expenses. Electronic remittance advice allows for easier reconciling and eliminates the need to re-key data into a practice management system.

    The additional value in working with us is that we represent hundreds of payers and combine what would have been multiple independent relationships into ONE relationship. Helping to consolidate data and simplify transactions.

    How can your system improve the quality of my data?

    EOP’s can be downloaded directly from the Zelis Payments portal in standard 835 or CSV format. There is no need to re-key data which can potentially lead to keying and posting errors.  Additionally, Zelis Payments’ unique integrations within payer core systems allow us to pull data beyond “check level” data, which means the data is inclusive of all uniform Claim Adjustment Reason Codes (CARCs), Remittance Advice Remark Codes (RARCs), and Claim Adjustment Group Codes (CAGs) to generate detailed, accurate, balanced error-free remittance data.

    Will this change the current process?

    Yes, we can make your current process more efficient with greater cost savings! Zelis Payments allows you to customize your consolidation and aggregation options to best fit your payment and data needs. Ask your Membership Services or Sales Representative for more details on your options.

    What are the benefits of utilizing the electronic remittance advice (ERA) standard?

    An ERA provides benefits for time and productivity among your system and staff. Data is easily uploaded into your HIT and the files contain a re-association trace number (TRN), which corresponds to the trace number in VRA payment files. Once both the bank data and 835 data is uploaded into your system they may be automatically settled.

    With Zelis Payments, data is aggregated, which means you receive one 835 file for all our payers and re-associated payment for each payer for days when payments are available – versus matching individual payments to individual EOPs – providing greater efficiency.