Zelis
Claims pricing, payment integrity, and payments for payers
Our take
Zelis is a healthcare payments company that sits between payers and providers. For health plans, BCBS plans, TPAs, and self-insured employers it prices out-of-network claims, edits and audits claims before payment, and moves the resulting payments electronically to providers and members. Providers touch the platform on the receiving end for payment delivery, reconciliation, and, since the Rivet acquisition, analytics on claim payment and denial trends. The company was formed in 2016 when Parthenon Capital merged Stratose and Premier Healthcare Exchange, then merged with Bain-backed RedCard in 2019 to add payments infrastructure.
Zelis serves more than 750 payers, including the top five national health plans, and reaches millions of providers and members. A November 2024 minority stake sale led by Mubadala, with Norwest and HarbourVest participating, followed reports of a valuation near $17 billion. In January 2026 it acquired Rivet to give providers visibility into payment and denial trends, then launched ZAPP Edge to give providers more transparency and control in the payment process. For a payer evaluating payment integrity vendors, Zelis is one of the established at-scale options; the main diligence work is on fee structures and overlap with tools already in place.
What it does
- Prepayment claims editing and payment integrity reviews
- Out-of-network pricing and network analytics
- Electronic provider payments replacing paper checks
- Member payments and explanation-of-benefits communications
- Claim payment and denial analytics for providers (Rivet)
Where it's strong
- Scale is real: 750+ payers including the top five national plans, so pricing and integrity models draw on enormous claim volume.
- One vendor covers pricing, integrity, and payment rails, which cuts the number of point solutions a plan has to stitch together.
- Well capitalized and acquisitive, with a valuation reported around $17B, so vendor viability risk is low.
What buyers should weigh
- Built for payers first; providers often encounter Zelis as the counterparty taking fees out of their payments rather than as their vendor.
- Its size and PE ownership can mean slower, more contractual engagement than younger vendors offer.
- Pricing and savings-share models deserve close scrutiny since fees often come out of claim savings.
Latest
Zelis acquired revenue cycle analytics company Rivet in January 2026 and folded its technology into the new ZAPP Edge provider payments product.
Also in Payment Integrity & Underpayments
Track this market
First Pass covers Payment Integrity & Underpayments and the rest of the getting-paid stack every week.