Zelis offers balanced network design based on each client’s unique goals, risk profile, and desired access to providers. This design is based on sophisticated analytics, claim benchmarks and market perspective that lets us offer the right provider coverage to ensure that networks are delivering optimal results. Our tailored network design is coupled with competitive savings solutions that find the best savings opportunities for every claim, every time.

Market Perspective

Zelis has developed a unique market perspective through our people, provider relationships and payer relationships. We have local provider contracting resources in multiple key markets as well as national contracting team members supporting broad network needs, providing insights that drive savings. Our ability to balance access requirements with costs and build network products that value all stakeholders leads to more thoughtful strategies for designing network and savings solution offerings. Providing all of our services through a single point solution allows us to deliver:

  • Network Management Expertise
  • Network Compliance
  • Network Analyses and Reporting for your clients
  • Administrative tasks as your complete savings solution
  • Extension of your systems through our scalable technology platform

Network Offerings

Zelis offers PPO network products to support the unique requirements of clients of all sizes looking for Group Health, Dental, or Workers’ Compensation coverage. Zelis has expertise in building its own network offering and partnering with brand name, trusted regional and national PPO networks. Our PPO offering can satisfy group access needs including the following network options.

  • Primary Network Management – Meeting specific access and cost control goals with a configurable PPO solution
  • Travel Network Access – Allowing employees to access network providers when out of their key market area
  • Supplemental Networks – Leveraging contracted solutions to reduce the plan and employee’s liability on out-of-network claims
  • Specialty Networks – Custom networks serving a particular specialty or narrow networks looking for controlled access with specific cost savings objectives

Savings Solutions

We enhance our network offerings with comprehensive savings solutions to deliver optimal value and results. Through a single connection with us, clients have access to proven, data-driven savings solutions including:

  • Orchestrated Routing – Managing network access and claim processing needs across multiple markets utilizing many network and clearinghouse relationships
  • Reference Based Pricing – Providing sustainable cost management solutions that fit every configuration you need, from a partner to help you scale as your business grows. Zelis RBP engages and balances the needs of all stakeholders: payers, plan sponsors, members, and providers.
  • Medicare Pricing Solutions – Offering Medicare based pricing services for those who wish to use alternatives to other cost containment products
  • Sophisticated Analytics – Delivering actionable network insights to payers nationwide and powering solutions with the industry’s only unified provider search
Zelis holds relationships with hundreds of affiliates nationwide, which allows us to tap into their savings. They listen to our challenges and help us find solutions.
Manager at a leading TPA