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 Advocacy and Legal Support
Surprise Balance Billing Solution
Zelis Is Your Surprise Balance Billing Partner
Reduce the pain of surprise balance bills
Even when patients carefully choose in-network facilities for treatment, they can still face balance bills if treated at the facility by out-of-network providers. In fact, 7 in 10 individuals with unaffordable medical bills did not know the provider was out-of-network at the time they received care.
Zelis Surprise Balance Billing Solution is an excellent option for plans seeking to address this growing concern. We leverage our in-house legislative expertise and our proprietary fee schedule to yield plan savings while reducing the risk of surprise balance billing.
Surprise Balance Billing Solution Components
- Legislative Toolkit: Developed by Zelis in-house legislative experts and legal team, used with our member advocacy and claims settlement programs
- Established Reimbursement Schedule (ERS): Zelis’ compliant, proprietary fee schedule provides a market-based, non-arbitrary and defensible reimbursement with a low appeal rate and high retained savings
- Member Financial Advocacy Program: Zelis advocates for your members, offering proactive member outreach and working to resolve balance bill disputes
- Claims Settlement Service: leverages in-house legislative expertise and reduces the risk of balance billing through post-payment settlement