How One Payer Used Market-Based Pricing to Drive Out-of-Network Savings
See how a regional healthcare payer expanded ERS market-based pricing to grow out-of-network savings while keeping provider disputes low.
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Zelis Established Reimbursement Solution®
Contain claims costs with market-aligned, customizable pricing that’s fair — and defensible.
Your Key to Lower Costs and Stronger Compliance
Pricing that holds up
Geographically adjusted, high-quality pricing that's defensible across all procedures and markets.
Strategies grounded in data
Reasonable, accepted payments for every procedure using public and commercially available benchmarks.
Intelligence you can trust
Commercial and proprietary methodologies eliminate arbitrary results and support defensible outcomes.
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Better Outcomes Before IDR: A TPA Case Study in NSA Performance
Explore how to use AI and automation improve healthcare claims management and how collaborating with experts can help.
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Proven Savings with SmartShopper
Discover the findings of the Wakely report, highlighting savings of $552 through SmartShopper participation and care transparency.
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Zelis Health Bill Assist℠ helped cut $52,000 in medical costs
Discover how expert advocacy and support from Zelis Health Bill Assist helped one member save $51,000 on an out-of-network medical bill.
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Market-based Pricing Resources
Reimagining P&C Claims Performance Webinar
Learn how P&C insurers can modernize medical payments, reduce manual work, accelerate claims workflows and improve claimant and provider experiences.
Payment Integrity Vendor Selection White Paper
See how US healthcare payers can choose the right payment integrity vendor, reduce provider abrasion and improve retained savings with smarter claims strategy.
Claims Analytics for Denial Management & Compliance White Paper
Learn how providers use claims analytics to spot denial patterns, reduce rework, manage compliance risk, and improve revenue cycle performance.
Frequently Asked Questions About Market-Based Pricing
Payers can reduce out-of-network costs by using market-based pricing that reflects geographically adjusted reimbursement rates, provider details and plan-specific preferences. Zelis creates customizable, sustainable savings by recommending reimbursement amounts that balance cost reduction with provider and member experience.
Market-based pricing can help reduce provider abrasion by creating more reasonable, transparent and defensible payment recommendations. Zelis supports this approach with a member advocacy program that includes provider and member education, helping payers pursue savings with less friction and a more sustainable reimbursement model.
Market-based pricing helps payers price out-of-network claims using a broader, more defensible approach than relying on a single benchmark, such as a fixed percentage of Medicare. Zelis uses multiple, publicly available commercial benchmarks, adjusts those rates based on the geographic area where services were provided to recommend fair, market-aligned reimbursements.
