Zelis (company)

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Zelis is a healthcare and financial technology company founded in 2016 and headquartered in Bedminster, New Jersey. In October 2019 Zelis Healthcare merged with RedCard Systems, a provider of healthcare payments and communications. The company, now called Zelis was ranked for 9^th time in 2019 by Inc.5000 with 3-year growth at 82%.

Zelis was formed as a consolidation platform with the intent of reducing the over 3 trillion dollars in errors, waste and abuse present in the U.S. healthcare system. The National Heath Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation's $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion. According to the latest data from the Institute of Medicine, healthcare fraud, waste, and abuse cost $750 billion, or 28 percent of total healthcare spending in 2009. And fraud alone represented about $75 billion of that wasteful spending. HHS OIG and the Department of Justice also charged over 600 individuals involved in healthcare fraud schemes in 2018, representing the largest healthcare fraud takedown to date.

Zelis' payments division was developed in response to the 2010 Affordable Care Act becoming more compliant. With health care payments accounting for over one in six dollars of the U.S. GDP 37 percent of medical claim payments and 88 percent of dental claim payments continue to paid by paper checks with electronic payments having a potential annual savings opportunity of $289 million for the healthcare industry.

Growth and Mergers

Since 2016 Zelis has remained active on the acquisition front. In February of 2017, Zelis acquired Maverest, one of the largest independent dental PPO networks in the United States. The company acquired Strenuus, the largest healthcare network analytics company in March of 2017. In November of 2017, Zelis acquired EthiCare Advisors, a healthcare cost management company based in Succasunna, NJ. In November 2018 Zelis acquired Netminder and its parent company, The Ignition Group, expanding their dental and vision network analytics.

Supported by Parthenon Capital, Bain Capital Private Equity and Bain Capital Ventures, Zelis Healthcare and RedCard Systems merged in October 2019. Combined this company works with 700 payers and more than 700k providers to price claims, pay claims and explain claims on a claim-to-claim basis.

References

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