Out-of-Network Services

Unlike others, our multi-layered, balanced approach dynamically delivers the highest level of claim savings for out-of-network claims

While other vendors using a traditional approach typically apply the first discount found which is not always the best discount — ClaimPass® digs deeper — using a multi-layered approach to utilize all applicable savings opportunities to find the best savings on out-of-network claims and to determine the best savings channels for those claims.

First, we work to get to the net cost of the claim by applying historical data, payment integrity technology, clinical and coding expertise, supportable benchmarks and scalable technology. This is important to ensure any savings and discounts are being applied on the lowest net claim cost rather than on an inflated price.

ClaimPass then determines the optimal discount by dynamically evaluating multiple savings options:

  1. Supplemental Networks
  2. Expert Negotiations
  3. Zelis Choice Provider Agreements
  4. Established Reimbursement Schedule

Importantly, ClaimPass offers choice and flexibility and is configurable to meet the needs of all types of payers. It is truly smart enough to know how to optimize claims savings while ensuring adherence to the business rules of the client. And we know it’s working. Our clients have enjoyed an increase in overall savings – up to 350%! – on their out-of-network claims.