Reference Based Pricing

Sustainable cost management that goes beyond cost shifting.

Unmatched flexibility to fit plan goals

Our comprehensive offerings support payers’ ability to administer many versions of Reference-Based Pricing (RBP) for better access to life counts and employer groups, including:

  • Full PPO network replacement
  • Out-of-network claims savings
  • A specifically designed option for tackling surprise balance billing on pathology, anesthesiology, radiology, and emergency claims

All of our RBP offerings also include:

  • Pricing, via Medicare Plus or proprietary fee schedule options
  • Processes for claims settlement and member advocacy, supported by our in-house legislative experts and compliance toolkit

Additional optional tools and services that enhance Zelis Reference-Based Pricing solutions:

  • Precertification
  • Member engagement
  • Implementation, including market analysis and product recommendations


Download our RBP white paper

Plan sponsors face tough choices when trying to balance plan savings, member satisfaction and provider abrasion. Read more about our comprehensive strategy that goes beyond cost shifting to include savings, fair and defensible reimbursements, expert support and member advocacy processes.