When claims errors, waste and abuse occur on out of network claims, we leverage ClaimPass, a multilayered Out-of-Network Services approach to out-of-network claims. Through this process, we use historical data, payment integrity output, supportable benchmarks and scalable technology to determine the net cost of the claim, enabling us to provide you the highest level of savings. Our approach combines coding and clinical intelligence with cost analytics to ensure the most appropriate reimbursement for care on every claim.
- Leverages contracted solutions to reduce the plan and employee’s liability on out-of-network claims
- Performs expert negotiations through an array of benchmark and provider historical data to determine rational payments for non-par claims
- Empowered by robust technology to ensure adherence to strict turnaround time requirements
- Flexible referenced-based pricing options available that support market needs through proprietary fee schedule pricing tools designed to control plan costs
- Medicare-based pricing solutions available as alternatives to in or out-of-network cost containment products
When integrated with our reference based pricing solution, Zelis’ claim settlement services provide balance billing support through its post-payment settlement program. Learn more >