Sustainable Cost Management

with Zelis Reference Based Pricing

Zelis Reference Based Pricing (RBP) provides 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.

The Zelis approach to Reference Based Pricing uses an array of solutions to effectively manage pricing for your claims.  Our solution encompasses proprietary technology, member advocacy, claims settlement, plan support, access to physician only networks, point of service notification,  implementation services, legislative and compliance expertise, and proactive provider relations.

RBP to Fit Your Plan Goals

Zelis offers unmatched flexibility with a comprehensive product offering, supporting the payer ability to sell and administer many versions of RBP to grow access to life counts and employer groups, including full PPO network replacement, Physician-only PPO with Hospital RBP, out of network claims savings, and an option specifically designed for tackling surprise balance billing on Pathology, Anesthesiology, Radiology, and Emergency claims.

Zelis RBP Solutions Chart

Each of these RBP options has at its core:

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

Zelis RBP is enhanced by additional, optional tools and services for members, payers, and plan sponsors.

Utilizing sophisticated analytics and our deep expertise in cost management we will recommend and administer a Reference Based Pricing strategy to meet your unique business requirements.

The results? Competitive savings. Low appeals rates. Minimized balance billing. Member satisfaction. And an RBP solution that’s flexible enough to fit every configuration you need and scales as you add groups and lives.

Analytics and RBP

Zelis offers the only Reference Based Pricing platform informed and enhanced by deep analytic capabilities. Our analytics are based on a vast library of claims, benchmarks and provider data that we aggregate and turn into actionable insights. By leveraging analytics Zelis is able to:

  • Demonstrate the potential impact of implementing an RBP solution
  • Identify patterns of egregious billing and uncover optimal discounts
  • Identify higher risk provider utilization
  • Make informed and objective recommendations on savings strategies
  • Design the best fit Reference Based Pricing solution on a client by client basis – a solution that meets plan goals, adapts to market changes, and delivers competitive advantage.

Download the White Paper

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

Visit our Knowledge Base to download the White Paper.