Provider Nexus API

JSON twin: https://www.healthaidb.com/software/provider-nexus-api.json

Company Name

Zelis

Product URL

https://marketplace.zelis.com/product/provider-nexus/

Company URL

https://www.zelis.com

Categories

• administrative Operations
• data Management
• provider Directory Management
• patient Engagement
• Administrative
• Provider Directory
• Provider Search Api
• Member Engagement

Summary

Provider Nexus API by Zelis offers a dynamic provider directory search, enabling seamless integration of provider data into benefit enrollment and member engagement platforms without the need for extensive data management.

Description

Provider Nexus API consolidates and standardizes provider network data from multiple carriers, providing a consistent multi-payer provider directory. It offers flexible search capabilities by geolocation, provider type, specialty, and other attributes, supporting various networks including commercial, Medicare, exchange, vision, dental, and behavioral health. The API ensures high availability with 99.99% uptime and fast response times, facilitating efficient provider searches within existing platforms.

Api Available

yes

Certifications

• ISO 27001
• SOC 2 Type II
• ISO 9001
• ISO 27018
• ISO 22301
• ISO 20000-1
• ISO 27017
• ISO 27035
• ISO 27032
• ISO 27031
• ISO 27036
• ISO 27037
• ISO 27038
• ISO 27039
• ISO 27040
• ISO 27041
• ISO 27042
• ISO 27043
• ISO 27044
• ISO 27045

Company Founding

1995

Company Offices

• United States
• India

Compliance

• HIPAA

Customers

• Scripps Health
• Zelis Payments

Data Residency

US/EU regions

Data Standards

• FHIR
• HL7 v2
• DICOM
• SNOMED
• ICD-10

Deployment Model

• SaaS

Features

• Multi-payer nationwide provider directory
• Highly configurable provider search API
• Data cleaning, standardization, and normalization across carriers
• Filter by custom attributes (e.g., premium designations, centers of excellence, enrollment codes, PCP IDs)
• Automated API monitoring for data integrity and error detection
• Support for commercial, Medicare, exchange, vision, dental, and behavioral health data
• Comprehensive developer documentation and API library
• White-labelable provider search for member-facing experiences

Id

SW2520

Integration Partners

• ServiceNow

Integrations

• Carriers / Health plans (multi-payer inbound data)
• Benefit administrators / TPAs / exchanges
• Zelis API Marketplace (other Zelis APIs and services)

Languages Supported

• English

Last Updated

2025-10-11

License

commercial

Market Segment

• enterprise
• smb

Optional Modules

• S365 (individual-carrier provider directory)
• Integration with Zelis API Marketplace services (ratings/reviews, digital health ID pass, rewards history)

Os Platforms

• Web

Pricing Details

contact vendor

Pricing Model

subscription

Privacy Features

• BAA available
• consent mgmt
• anonymization
• data minimization

Product Code

SW2520

Product Name

Provider Nexus API

Ratings

• 3.9/5 (17 reviews) - G2
• 4.3/5 (14 reviews) - G2
• 4.0/5 (16 reviews) - G2
• 4.5/5 (2 reviews) - G2
• 5.0/5 (2 reviews) - G2

Regions Available

• United States
• India

Related Urls

• https://elion.health/products/zelis-provider-nexus

Release Year

2016

Security Features

• Encryption
• RBAC
• SSO/SAML
• audit logs
• 2FA
• DLP

Specialties

• Primary Care
• Behavioral Health
• Dental
• Vision
• Specialty Care

Support Channels

• email
• phone
• chat
• ticketing
• community
• 24x7

System Requirements

Target Users

• payers
• third-party administrators (TPAs)
• benefit administrators
• brokers/consultants
• healthcare IT developers/partners
• health plan product managers
• call center/admin staff

Training Options

• documentation
• webinars
• live_online
• onsite
• certification

Type

product

User Reviews

• The team is comprised of agile and tenacious people who are willing to take risks and make sure that their actions are consistent and effective.
• I have worked with Lorie P on getting multiple Tax IDs set up to get enrolled in Zelis Payments, and she makes the process so smooth and easy. She is so kind and I look forward to having to set up a new account to get a chance to talk to her. Once set up, the system works smoothly and easily transmits 835 files to our clearinghouse so we don't have to manually post payments.
• Haley has taken Scripps under her wing and has supported us with EFT registration. She is responsive and educated.
• I deeply resent this company for signing me up for services I do NOT want and forcing it on me against my will so that I have to spend two hours on the phone once a year reversing it.

Version

1.0

Alternatives

See related products

Canonical JSON

{
  "product_name": "Provider Nexus API",
  "company_name": "Zelis",
  "product_url": "https://marketplace.zelis.com/product/provider-nexus/",
  "company_url": "https://www.zelis.com",
  "related_urls": [
    "https://elion.health/products/zelis-provider-nexus"
  ],
  "product_code": "SW2520",
  "summary": "Provider Nexus API by Zelis offers a dynamic provider directory search, enabling seamless integration of provider data into benefit enrollment and member engagement platforms without the need for extensive data management.",
  "description": "Provider Nexus API consolidates and standardizes provider network data from multiple carriers, providing a consistent multi-payer provider directory. It offers flexible search capabilities by geolocation, provider type, specialty, and other attributes, supporting various networks including commercial, Medicare, exchange, vision, dental, and behavioral health. The API ensures high availability with 99.99% uptime and fast response times, facilitating efficient provider searches within existing platforms.",
  "categories": [
    "administrative Operations",
    "data Management",
    "provider Directory Management",
    "patient Engagement",
    "Administrative",
    "Data Management",
    "Provider Directory",
    "Provider Search Api",
    "Member Engagement"
  ],
  "market_segment": [
    "enterprise",
    "smb"
  ],
  "target_users": [
    "payers",
    "third-party administrators (TPAs)",
    "benefit administrators",
    "brokers/consultants",
    "healthcare IT developers/partners",
    "health plan product managers",
    "call center/admin staff"
  ],
  "specialties": [
    "Primary Care",
    "Behavioral Health",
    "Dental",
    "Vision",
    "Specialty Care"
  ],
  "regions_available": [
    "United States",
    "India"
  ],
  "languages_supported": [
    "English"
  ],
  "pricing_model": "subscription",
  "pricing_details": "contact vendor",
  "license": "commercial",
  "company_offices": [
    "United States",
    "India"
  ],
  "company_founding": "1995",
  "deployment_model": [
    "SaaS"
  ],
  "os_platforms": [
    "Web"
  ],
  "features": [
    "Multi-payer nationwide provider directory",
    "Highly configurable provider search API",
    "Data cleaning, standardization, and normalization across carriers",
    "Filter by custom attributes (e.g., premium designations, centers of excellence, enrollment codes, PCP IDs)",
    "Automated API monitoring for data integrity and error detection",
    "Support for commercial, Medicare, exchange, vision, dental, and behavioral health data",
    "Comprehensive developer documentation and API library",
    "White-labelable provider search for member-facing experiences"
  ],
  "optional_modules": [
    "S365 (individual-carrier provider directory)",
    "Integration with Zelis API Marketplace services (ratings/reviews, digital health ID pass, rewards history)"
  ],
  "integrations": [
    "Carriers / Health plans (multi-payer inbound data)",
    "Benefit administrators / TPAs / exchanges",
    "Zelis API Marketplace (other Zelis APIs and services)"
  ],
  "data_standards": [
    "FHIR",
    "HL7 v2",
    "DICOM",
    "SNOMED",
    "ICD-10"
  ],
  "api_available": "yes",
  "system_requirements": "",
  "compliance": [
    "HIPAA"
  ],
  "certifications": [
    "ISO 27001",
    "SOC 2 Type II",
    "ISO 9001",
    "ISO 27018",
    "ISO 22301",
    "ISO 20000-1",
    "ISO 27017",
    "ISO 27035",
    "ISO 27032",
    "ISO 27031",
    "ISO 27036",
    "ISO 27037",
    "ISO 27038",
    "ISO 27039",
    "ISO 27040",
    "ISO 27041",
    "ISO 27042",
    "ISO 27043",
    "ISO 27044",
    "ISO 27045"
  ],
  "security_features": [
    "Encryption",
    "RBAC",
    "SSO/SAML",
    "audit logs",
    "2FA",
    "DLP"
  ],
  "privacy_features": [
    "BAA available",
    "consent mgmt",
    "anonymization",
    "data minimization"
  ],
  "data_residency": "US/EU regions",
  "customers": [
    "Scripps Health",
    "Zelis Payments"
  ],
  "user_reviews": [
    "The team is comprised of agile and tenacious people who are willing to take risks and make sure that their actions are consistent and effective.",
    "I have worked with Lorie P on getting multiple Tax IDs set up to get enrolled in Zelis Payments, and she makes the process so smooth and easy. She is so kind and I look forward to having to set up a new account to get a chance to talk to her. Once set up, the system works smoothly and easily transmits 835 files to our clearinghouse so we don't have to manually post payments.",
    "Haley has taken Scripps under her wing and has supported us with EFT registration. She is responsive and educated.",
    "I deeply resent this company for signing me up for services I do NOT want and forcing it on me against my will so that I have to spend two hours on the phone once a year reversing it."
  ],
  "ratings": [
    "3.9/5 (17 reviews) - G2",
    "4.3/5 (14 reviews) - G2",
    "4.0/5 (16 reviews) - G2",
    "4.5/5 (2 reviews) - G2",
    "5.0/5 (2 reviews) - G2"
  ],
  "support_channels": [
    "email",
    "phone",
    "chat",
    "ticketing",
    "community",
    "24x7"
  ],
  "training_options": [
    "documentation",
    "webinars",
    "live_online",
    "onsite",
    "certification"
  ],
  "release_year": "2016",
  "integration_partners": [
    "ServiceNow"
  ],
  "id": "SW2520",
  "slug": "provider-nexus-api",
  "type": "product",
  "version": "1.0",
  "last_updated": "2025-10-11",
  "links_json": {
    "self": "https://www.healthaidb.com/software/provider-nexus-api.json"
  }
}