Solution will address fragmented healthcare cost containment offerings for self-insured employers while freeing members from network limitations.
Bedminster, N.J. – May 15, 2023 – Zelis®, a healthcare technology company modernizing the healthcare financial experience for all, today announced the launch of its new open access pricing solution. Self-funded employers, which represent 65% of U.S. workers, often struggle to sustain the cost of traditional health plan premiums, and existing solutions are often fragmented and have not delivered a satisfactory experience for members in accessing and navigating care.
To overcome these challenges, third-party administrators need to bring alternative strategies to stabilize claims costs, improve provider accountability related to rising fees, and free patients from network limitations.
Zelis Open Access Pricing® is a reference-based pricing (RBP) solution that empowers self insured employers and third-party administrators to put their members’ experience first while also stabilizing rising healthcare costs.
The new solution allows clients to set maximum reimbursement amounts using pre-defined prices which allows for more predictable cost forecasting. At the same time, Zelis Open Access Pricing® employs a member advocacy team that provides pre-service member education, navigation support, provider contracting support, balance bill resolution, and legal escalation support to ensure seamless interactions among payers, providers, and members. The technology-enabled solution includes modeling and analytics, contract management, and performance reporting, as well as a price and provider transparency application to drive member adoption.
“By combining Payer Compass with Zelis, we have joined advanced technology and best-in class approaches to create this RBP solution to managing rising healthcare claims costs for clients and their members.” – Amanda Eisel, Zelis CEO.
Zelis Open Access Pricing® gives members the freedom to choose their preferred healthcare providers, and offers fair, established pricing benchmarks that keep medical expenses under control.
“TPAs and self-funded groups want reference-based pricing for lower claims costs, configurable options, more predictable healthcare cost forecasting, and more. We are excited to bring to market a fully integrated solution that fits their needs and enhances the experience for their members.”- Rick Ellsworth, SVP, GM Payer Compass at Zelis.
To learn more, visit www.zelis.com.
About Zelis
Zelis is modernizing the healthcare financial experience by providing a connected platform that bridges the gaps and aligns interests across payers, providers, and healthcare consumers. This platform serves more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, and millions of healthcare providers and consumers. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. Learn more at Zelis.com and follow us on LinkedIn to get the latest news.
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