Reference Based Pricing

A comprehensive savings strategy tailored to fit plan goals.

Competitive savings. Fewer appeals. Reduced surprise balance billing. All integrated with your current systems for minimal process disruption.

 

 

Unmatched flexibility and experience

Zelis supports the payer’s ability to administer any iteration of Reference Based Pricing (RBP), whether for certain out-of-network claims only or as a full or partial network replacement. Zelis RBP delivers a sustainable savings strategy through unmatched flexibility with pricing, network configuration, member advocacy and support services all tailored to meet unique plan needs.

Pricing Options

Unlike other RBP approaches, Zelis provides a choice of pricing options and guidance for the best pricing strategy.

  • RBP for Out-of-Network Savings: Zelis recommends using our proprietary market-based fee schedule, Established Reimbursement Solution (ERS)
  • RBP for PPO Replacement: Zelis recommends using our proprietary Medicare Pricing Solution (MPS)

Comprehensive support services for sustainable RBP

Clients may choose to customize their Zelis RBP strategy with a range of innovative tools and services designed to advocate for members, improve transparency, manage risk and drive savings.

  • Pre-Service Payer and Member Support
  • Claim Settlement and Inquiry Management
  • Member Financial Advocacy and Legal Support
RBP Infographic

Surprise Balance Billing Solution

Zelis Is Your Surprise Balance Billing Partner

The No Surprises Act (NSA) and Transparency in Coverage Rule (TiC) have introduced new requirements and complexity to out-of-network (OON) claim processing and reimbursement strategies.

Learn more about how Zelis can help you address these new requirements.