Top Zelis Alternatives, Competitors & Similar Software

Bundled Pay Management Software

HealthEdge is on a mission to drive a digital transformation in healthcare. We’re connecting health plans, providers, and patients with end-to-end digital technology solutions to support new business models, reduce administrative costs and improve health outcomes. Our growing portfolio of products (HealthRules® Payer, HealthEdge Source™, HealthEdge® Provider Data Management, GuidingCare®, and Wellframe™) provides talented and passionate professionals with opportunities to lead change and make a lasting, global impact in healthcare. Driving our mission are 2,000+ professionals worldwide. Together, we are committed to innovating a world where healthcare can focus on people.

Bundled Pay Management Software

Veradigm is an integrated data systems and services company that combines data-driven clinical insights with actionable tools to help healthcare stakeholders improve the quality, efficiency, and value of healthcare delivery—these stakeholders include biopharma, health plans, healthcare providers, network partners, and most importantly, the patients they serve. We build solutions that are designed to help healthcare stakeholders to improve patient lives through data driven insights. We are dedicated to simplifying the complicated healthcare system with next-generation technology and solutions, transforming healthcare from the point-of-patient care to everyday life. As a result, Veradigm attracts leaders in healthcare, technology, and innovation, seeking to work with us to deliver insights and solutions to the benefit the healthcare ecosystem with the objective being to improve healthcare quality while lowering the cost of healthcare. Veradigm is an organization comprised of passionate and energetic people whose everyday focus is on helping all healthcare stakeholders drive the best care possible for healthier communities. We believe diversity is the foundation of innovation, and we are dedicated to fostering an inclusive environment that supports the talents of all people.

Bundled Pay Management Software

Simplify Healthcare enables Payers to achieve growth and cost efficiencies with its industry-leading platform, people, and processes. Established in 2008, Simplify Healthcare has taken on some of the toughest challenges facing payers by simplifying payer operations, connecting their front, middle, and back office with a payer-focused platform-centric approach. Our offerings — Benefits1™, Provider1™, Claims1™, and Xperience1™ offer precise solutions to complex challenges in delivering rich products, benefits, and provider data. SimplifyX™ is an AI-first enterprise company pioneering agentic AI to transform how organizations design, operate, and scale solutions by embedding intelligent agents directly into workflows. Benefits1™ — A unified platform for configuring, filing, publishing, and governing benefits across Medicare, Medicaid, ACA, Group, and Medigap. Provider1™ — A unified, yet modular, platform that automates provider roster file management, data management, onboarding, contracting, credentialing, and claims configuration. Claims1™ — The solution standardizes and automates how payers configure claims platforms like TriZetto® Facets® and QNXT™, homegrown systems, and other top 5 Core Admin platforms—reducing rework, ensuring accuracy, and improving data reliability by 99%. Xperience1™ — Enables payers to streamline and elevate benefits communication across the entire member journey, from plan shopping and enrollment to customer service and self-service. Simplify Docs™ — Delivers seamless document generation and language translation workflows for all mandated materials (ANOC, EOC, SB, SBC, etc.) and non-mandated content (Benefit Highlights, Rider Booklets, etc.) across all lines of business. SimplifyX™ — Industry-specific, production-ready enterprise applications with intelligent AI Agents orchestrating every step from requirements to release.

Bundled Pay Management Software

Simplify Healthcare enables Payers to achieve growth and cost efficiencies with its industry-leading platform, people, and processes. Established in 2008, Simplify Healthcare has taken on some of the toughest challenges facing payers by simplifying payer operations, connecting their front, middle, and back office with a payer-focused platform-centric approach. Our offerings — Benefits1™, Provider1™, Claims1™, and Xperience1™ offer precise solutions to complex challenges in delivering rich products, benefits, and provider data. SimplifyX™ is an AI-first enterprise company pioneering agentic AI to transform how organizations design, operate, and scale solutions by embedding intelligent agents directly into workflows. Benefits1™ — A unified platform for configuring, filing, publishing, and governing benefits across Medicare, Medicaid, ACA, Group, and Medigap. Provider1™ — A unified, yet modular, platform that automates provider roster file management, data management, onboarding, contracting, credentialing, and claims configuration. Claims1™ — The solution standardizes and automates how payers configure claims platforms like TriZetto® Facets® and QNXT™, homegrown systems, and other top 5 Core Admin platforms—reducing rework, ensuring accuracy, and improving data reliability by 99%. Xperience1™ — Enables payers to streamline and elevate benefits communication across the entire member journey, from plan shopping and enrollment to customer service and self-service. Simplify Docs™ — Delivers seamless document generation and language translation workflows for all mandated materials (ANOC, EOC, SB, SBC, etc.) and non-mandated content (Benefit Highlights, Rider Booklets, etc.) across all lines of business. SimplifyX™ — Industry-specific, production-ready enterprise applications with intelligent AI Agents orchestrating every step from requirements to release.

Bundled Pay Management Software

IntegriChain is a provider of pharmaceutical data and related cloud software. The company provides a channel management cloud software used by life sciences suppliers to drive channel collaboration and to improve the efficiency of how products reach customers by embedding big-data customer insights into daily business processes. The company was founded in 2005 and is headquartered in Philadelphia, Pennsylvania. It seeks to expand its core operations through mergers and acquisitions.

Bundled Pay Management Software

Vālenz Health® is the platform to simplify healthcare – the destination for employers, payers, providers, and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from member experience to payment integrity, plan performance, and provider quality. Valenz elevates expectations to a new level of efficiency, effectiveness, and transparency where smarter, better, faster healthcare is possible. For more information, visit valenzhealth.com.

Bundled Pay Management Software

NantHealth, a member of the NantWorks ecosystem of companies, provides enterprise solutions that help businesses transform complex data into actionable insights. By offering efficient ways to move, interpret, and visualize complex and highly sensitive information, we enable customers in healthcare, life sciences, logistics, telecommunications and other industries to automate, understand and act on data while keeping it secure and scalable. Our product portfolio comprises the latest technology in payer-provider collaboration platforms for real-time coverage decision support, and data solutions that provide multi-data analysis, reporting and professional services offerings.

Bundled Pay Management Software

Inovaare is a trusted leader in AI-powered compliance solutions for U.S. healthcare payers. Our AI-powered automation solutions empower health plans to streamline operations, achieve regulatory compliance, and enhance both employee and member experiences. Our specialized healthcare cloud platform, with all current federal and state regulatory protocols built in, mitigates risks, automates workflows, and reduces cost for healthcare stakeholders. Our Core Solutions 1. Usher AI – Intelligent Compliance Assistant • Conversational AI trained in CMS regulations • Real-time CMS universe analysis & interpretation • Natural language regulatory search 2. Appeals & Grievances Management – Automate with Precision • Automated intake & triage • Built-in compliance workflows • Letter module for outreach • One-click regulatory & universe reporting One-click regulatory & universe reporting 3. Regulatory Compliance – Stay Audit-Ready • Centralized CMS regulatory libraries • Auto-generated policies to close gaps • Issue detection & remediation Automated Corrective Action Plan workflows 4. Delegation Oversight – Stronger Vendor Management • Centralized delegate oversight • Automated monitoring dashboards • Real-time compliance tracking & audit trails 5. Universe Management System (UMS) – Automate CMS Prep • Auto-generation of CMS universe files • Alignment with changing rules • Built-in validation to reduce errors • Early visibility into compliance risks 6. Audit & Monitoring – Continuous Oversight • Automated workflows for audits • Real-time KPI dashboards • AI-powered audit co-pilot assistance Why Healthcare Leaders Choose Inovaare • Purpose-Built for Healthcare Compliance – Designed to meet CMS standards today & tomorrow • AI-Driven Efficiency – Intelligence that improves accuracy and productivity • Secure & Scalable – HIPAA-compliant, HITRUST-certified, built for organizations of all sizes

Bundled Pay Management Software

Developer of a payment processing software designed to help healthcare providers collect more patient payments. The company's software offers real-time payment solutions with flexible payment options allowing them to capture more revenue at multiple points of the revenue cycle and provide a more positive patient experience, enabling government agencies, hospital systems and other commercial businesses to collect payments.

Bundled Pay Management Software

HealthAxis is at the forefront of transforming healthcare delivery in the United States through state-of-the-art technological solutions. AxisCore™, our cutting-edge core administrative processing system (CAPS) technology, alongside AxisConnect™, our modern suite of business process as a service (BPaaS), business process outsourcing (BPO), staff augmentation, and consulting capabilities, empowers payers, risk-bearing providers, and third-party administrators to optimize their operations, elevate efficiency, and enhance member engagement. By addressing pivotal challenges faced by payers, we are committed to improving member and provider experiences, thereby fostering more positive outcomes and contributing to the advancement of a healthier future.

Bundled Pay Management Software

CAQH is the trusted data connector at the core of healthcare. For more than two decades, the organization has powered the industry with the largest and most complete healthcare data foundation in the U.S., connecting more than 4.8 million provider records and 225 million member records across nearly 1,000 health plans and partners. By improving how essential information flows across the system, CAQH makes healthcare operate more efficiently and with greater confidence. Learn more at CAQH.org. View current openings for CAQH Careers at www.caqh.org/about/careers

Bundled Pay Management Software

PLEXIS Healthcare Systems is a leading payer technology company delivering trusted enterprise core administration and claims management solutions to healthcare payers and delivery systems worldwide. More than 100 organizations trust PLEXIS core administrative enterprise solutions to manage over 55 million lives in all 50 states and around the world. PLEXIS provides mission-critical solutions that catalyze efficiencies and connect evolving business ecosystems to a wide range of payer organizations.

Bundled Pay Management Software

Sift Healthcare provides advanced decision support solutions for managing the increasingly complex healthcare revenue cycle, integrating machine learning and predictive analytics to reduce insurance denials.

Bundled Pay Management Software

By designing a next-generation clinical NLP engine supporting advanced documentation and coding functions, EZDI turned their vision to reality. Their CAC and CDI solutions received tremendous feedback, providing system accuracy and ease of use. EZDI removes the data complexity and highlights what matters for healthcare professionals.

Bundled Pay Management Software

Our mission is to fix healthcare through payment reform and we are dedicated to helping our partners succeed at all stages of this long journey. As the payor and provider worlds converge, healthcare organizations have a myriad of opportunities to manage care and risks in new ways. Archway Health works with providers to illuminate these opportunities and design, execute, and finance the care and risk management programs that fit best with their capabilities. As a firm, Archway understands that heath care isn't a "one size fits all"​ industry, and what works for one provider won't necessarily work for another. When we engage with a healthcare organization, our first goal is to understand the provider's strengths and capabilities, the populations served, their experience with improving care while reducing costs, and their performance relative to others in the market. We also know that health care is a local business, and markets evolve in very different ways, presenting different types of opportunities. These include combinations of Medicare ACO's, Commercial Global Capitation, Bundled Payments, Dual Eligible Programs, Medicare Advantage Plans, Medical Homes, and Complex Care Carve - Outs. Archway partners with our clients'​ leadership to design the care and risk management programs that match their unique capabilities with targeted opportunities and partners in the market. Once the optimal care and risk management programs are designed, Archway shares risk with its clients by providing financing to cover reserve requirements and protect against unexpected downside losses. The Archway team has significant experience designing care management models geared towards improving quality and reducing costs as patients move along the care continuum. Please visit us at http://archwayhealth.com/, e-mail us at [email protected], or contact us at 617-209-7985 to learn more about what we have to offer.

Bundled Pay Management Software

Founded in 2004, Dynafios continues to grow and expand throughout the healthcare industry. We focus on delivering innovative products and services to help health systems and care delivery transform in a “value” based environment. Our seasoned team of analysts and consultants work closely with each client to improve the clinical process of care, patient experience, operational efficiencies, and outcomes which are all critical in today’s environment. The Dynafios difference begins with our expertise and ability to assist hospitals and health systems with strategic planning, development, and implementation of new approaches that create high performing healthcare organizations.

Bundled Pay Management Software

At Simple Fractal, we take pride in being the premier automation partner for ABA providers. With nearly a decade of collaboration with the industry's largest providers, our in-depth understanding of the specific processes and technology platforms in the ABA sector sets us apart. Our team's extensive operational and automation experience is further enriched by industry veterans, including the former CIO of Autism Learning Partners and former Director of Strategic Initiatives at LEARN Behavioral, bringing unparalleled subject matter expertise to our solutions. At Simple Fractal, we've mastered the art of tailoring automation solutions that perfectly fit the nuanced needs of ABA therapy providers. Our stellar engineering and dedicated maintenance teams have developed over 100 bots that efficiently handle essential functions in Revenue Cycle Management (RCM), Client Services, and HR compliance, ensuring our clients can focus more on delivering exceptional care and serving more families in need of their services. The effectiveness of our solutions is proven by our track record: with ROIs exceeding 10X and bots in continuous operation for 6+ years, we have earned 4.9 out of 5-star rating on G2. An independent report by KLAS Research further validates our success, with 100% of our clients meeting all expected outcomes from our engagements, all of which are now expanding their partnership with us. Building on our achievements with the largest ABA providers, Simple Fractal is committed to making our cutting-edge automation solutions accessible to mid-market providers. We are also exploring expansion into related verticals within the health and human services sector, aiming to leverage our automation expertise to benefit a broader range of organizations. Our approach of combining deep industry knowledge with technical excellence and dedicated support has stood the test of time. For ABA providers looking to level up and grow, Simple Fractal is your dedicated partner.

Bundled Pay Management Software

26+ YEARS OF INNOVATION IN HEALTHCARE We are at the forefront of the industry, offering fully integrated, customizable workflow solutions, revenue cycle management, and patient management software. Our specialty lies in the optimization of organizational workflows and the application of Robotic Process Automation (RPA) to healthcare processes. Our commitment to innovation and excellence is driven by our mission to empower healthcare organizations with the tools they need to provide efficient, cost-effective, and patient-centric care.

Bundled Pay Management Software

Health plan administration involves many moving parts. We help Healthcare Payers organize their data, vendors, and business processes behind one login so they can efficiently manage the different pieces of the health plan in one place. For more than 25 years, Third Party Administrators, Health Plans, International Insurance Carriers, Government Payers, Employers, and Health Trusts worldwide have achieved greater efficiencies and greater marketability through their partnership with Health Portal Solutions. Schedule your demo at www.hpsglobal.net.

Bundled Pay Management Software

Strategic Healthcare Management Systems (SHMS) is a Medicare Advantage Health Plan software and services company which streamlines and strengthens core business processes in today’s challenging, competitive, and changing healthcare payer industry. The SHMS software is ideal to manage CMS contracts for Medicare Advantage, ACOs, Dual Eligible, and other single beneficiary products.