Refine the medical billing infrastructure to reduce the bottlenecks for payment for providers and payers

The American system for paying health care is plagued by fragmentation, delays and administrative waste – 25% of health costs go to manual processes. Suppliers continue the missing payments and find it difficult to reconcile complaints through redundant portals. Meanwhile, payers, which are not built to function as banks, are faced with frustrated ineffectiveness and partners. The persistent disconnection between payments and data led to eroded confidence and wasted resources for everyone in the system.

Yusuf Qasim, President of Zelis’ payment activity, co-founded Pay-Plus Solutions in 2011. After its acquisition by Zelis in 2019, Qasim helped build what was going to become ZAPP-The Advanced Payment Plaw Zelis. This started as a solution to digitize checks for third -party administrators has become a robust payment infrastructure now serving payers and now suppliers. In an interview, Qasim has spoken of some of the challenges that the health care industry faces navigation on health care payments. He also discussed how Zelis only transforms how health care is operationaling payments taking advantage of modern capacities.

“We knew that the system was not designed for real -time efficiency,” said Qasim. “We wanted to go beyond regulatory compliance and create something friendly, consumer-oriented and, ultimately, transformer.”

The absence of coherent and reliable data and information behind health care payments is enormous damage to suppliers, both in terms of administrative burden and knowledge on affairs and income cycles. “The main questions asked by the suppliers are:” When will I be paid? “And” why is this statement stuck? “said Qasim. “For the moment, the system is not facilitating them.”

Introduced in 2024 as the first payment and integrated communication platform for industry, ZAPP addresses this question on the front. The platform digitizes, consolidates and provides payments and data from its growing network of more than 550 payers. This, in turn, reduces a large part of the administrative burden of providers associated with health payments and accelerates cash flows.

By automating tedious back office tasks, it allows suppliers to focus on organizational growth and patient care rather than troubleshooting.

The push by regulators in 2010 to oblige payers to offer a form of digital payment offer provided Zelis a huge rear wind, according to Qasim. At the same time at the same time, CMS published more advice on electronic payments.

“They were starting to establish the reference standards. But we really decided to go further,” said Qasim. “We wanted to make our platform not only something that was motivated by the regulations. We wanted to be adapted to consumers and adapted to businesses and, along the way, make sure that our paid customers and suppliers knew they had the choice of how the payments were received. ”

The impact of ZAPP is striking: in their work with an integrated delivery network (IDN) based in Arizona, said once two months have taken two months now clear in just two days. The electronic payment volume has doubled and administrative waste has been reduced.

“Reduction of costs and complexity has made everyone happier,” said Qasim. “Better data hygiene means fewer payment anomalies, faster cash flows and less conjectures.”

About a quarter of health expenses go to the general administrative costs. Repairing the payment piece is not only a question of speed – it is a question of making the collaboration possible.

The rationalization of the payment process, accelerating it, associated with the provision of precise and secure data means less payment disputes, better cash flows and faster resolutions, which promotes confidence and facilitates collaboration, said Qasim.

Asked about the innovations in the payment technology that Zelis envisages in the next 5 years, he predicts the rise of agency AI – autonomous programs that optimize decision -making for users – and a world where payments take hours, not days.

But with digitization, it comes from responsibility.

“Cybersecurity must remain in the center and the center,” warned Qasim. “While we rely on AI, we must strengthen confidence by transparency, which did not allow algorithms to become black boxes.”

For suppliers hesitating for digital payments, Qasim requests an open state of mind. He thinks that collaborative automation can eliminate the charges they face today.

The transformation of health care payments by Zelis is not only an upgrade of technology – it is a change of mind. By making data more accessible, smarter workflows and friction payments, this helps suppliers and payers to focus on what matters: the service provision.

What about patients? A more transparent payment ecosystem means fewer billing errors, faster authorizations and clearer experience sailing the cost of care.

Health care is difficult, but it shouldn’t be chaotic. With platforms like ZAPP, clarity is finally within reach

Photo: Blackjack3D, Getty Images