JSON twin: https://www.healthaidb.com/software/zelis-provider-nexus.json
Zelis
https://www.zelis.com/solutions/member-engagement/provider-decision-support/
Zelis Provider Nexus is a multi‑payer provider directory and API that consolidates, cleans, and standardizes provider and facility data from multiple carriers to power searchable provider directories and member decision‑support tools.
Provider Nexus ingests provider data from multiple payers and carriers, standardizes and applies business rules, and exposes configurable search endpoints via an API. It supports nationwide provider/facility search across commercial, Medicare, exchange, vision, dental and behavioral health lines, offers automated API monitoring and documentation for developer integration, and is marketed to payers, TPAs, benefit administrators, brokers and healthcare IT partners.
yes
1995
P1843
2025-09-07
commercial proprietary
contact vendor for pricing, tiering and trial information
enterprise_quote
product
1.0
{
"company_name": "Zelis",
"company_url": "https://www.zelis.com",
"company_offices": [
"United States",
"India"
],
"company_founding": "1995",
"product_url": "https://www.zelis.com/solutions/member-engagement/provider-decision-support/",
"categories": [
"member engagement",
"provider directory",
"provider search API",
"administrative",
"data management"
],
"market_segment": [
"enterprise",
"payer"
],
"links": [
"https://www.zelis.com/solutions/member-engagement/provider-decision-support/",
"https://www.zelis.com",
"https://www.zelis.com/connect-with-zelis/",
"https://marketplace.zelis.com/provider-nexus-use-case/",
"https://elion.health/products/zelis-provider-nexus",
"https://www.g2.com/products/zelis/reviews",
"https://klasresearch.com/vendor-ratings/zelis-healthcare/83034",
"https://www.zelis.com/company/"
],
"summary": "Zelis Provider Nexus is a multi‑payer provider directory and API that consolidates, cleans, and standardizes provider and facility data from multiple carriers to power searchable provider directories and member decision‑support tools.",
"description": "Provider Nexus ingests provider data from multiple payers and carriers, standardizes and applies business rules, and exposes configurable search endpoints via an API. It supports nationwide provider/facility search across commercial, Medicare, exchange, vision, dental and behavioral health lines, offers automated API monitoring and documentation for developer integration, and is marketed to payers, TPAs, benefit administrators, brokers and healthcare IT partners.",
"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"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "contact vendor for pricing, tiering and trial information",
"license": "commercial proprietary",
"deployment_model": [
"SaaS"
],
"os_platforms": [
"Web"
],
"features": [
"Multi-payer nationwide provider directory",
"Highly configurable provider search API (search endpoints and results)",
"Data cleaning, standardization and normalization across carriers",
"Filter by custom attributes (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, 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": [],
"api_available": "yes",
"system_requirements": "",
"compliance": [
"HIPAA"
],
"certifications": [],
"security_features": [
"API access controls (API keys/token-based access)",
"Encryption (in transit and at rest)",
"Audit logging",
"Role-based access controls (RBAC)",
"Developer portal access controls"
],
"privacy_features": [
"BAA available",
"Data access controls",
"Provider data standardization to minimize inconsistent data exposure"
],
"data_residency": "",
"customers": [
"ACS Benefit Services",
"AmeriBen",
"BRMS",
"More than 770 payers (enterprise payers and carriers)",
"TPAs",
"Health plans",
"Hospitals / health systems",
"Ambulatory practices"
],
"user_reviews": [
"Quick response from support and knowledgeable representatives who help troubleshoot integration issues.",
"API documentation was comprehensive but required engineering effort to customize to our business rules.",
"Provider data often improved search accuracy, though we encountered occasional non-conformity with local provider identifiers.",
"Support response times can be slow during peak periods and escalation paths were sometimes unclear.",
"Automated API monitoring helped us catch application errors before they affected members."
],
"ratings": [
"G2 - reported component scores: Ease of Use ~7.5/10, Support ~6.3/10 (user-submitted review metrics)",
"ITQlick - 4.4/5 (product rating summary)",
"KLAS - Zelis Payment Integrity named Best in KLAS (overall performance score 93.9/100) referenced for Zelis product family",
"BBB - Zelis Payments, LLC profile (accredited business listing and customer complaints listed)"
],
"support_channels": [
"phone",
"email",
"ticketing",
"account manager",
"request-meeting / sales support"
],
"training_options": [
"documentation (API docs)",
"webinars",
"live_online (implementation support)",
"professional services / onboarding"
],
"release_year": "",
"integration_parents": [],
"integration_partners": [
"Carriers / payers (multi-payer data sources)",
"Third-Party Administrators (TPAs)",
"Benefit administrators",
"Brokers & consultants",
"Exchanges",
"Zelis API Marketplace"
],
"id": "P1843",
"slug": "zelis-provider-nexus",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/zelis-provider-nexus.json"
}
}