Zelis^® Healthcare Provider Solutions

Zelis is a pricing, payments, and member support partner that supports health plans and third-party administrators. While we’re not the payer, we recommend pricing that’s based on individual plan preferences, regulatory guidelines, and market-based benchmarks—all with the goal of balancing fairness for providers and sustainability and compliance for plans. Our goal is to support timely, reasonable payment while reducing administrative friction for providers and payers alike.

If EOP remark language references us, it simply means the payer used our services during claim processing to help recommend reimbursement for an out-of-network claim. You’ll still be paid by the plan – our role is to support the payer and recommend fair reimbursement and streamline the claim pricing process.

In some cases, Zelis is not referenced in the remark language, but our logo or name may appear elsewhere on the EOP. This indicates that the plan partners with Zelis to deliver their healthcare payments or claims communications. You can learn about payments solutions for providers here.

Each payer sets their own process, but if Zelis was involved in recommending pricing on your claim, the explanation of payment (EOP) or remittance advice includes details on how to dispute or request a review. We’re committed to working together to resolve your questions. We offer hands-on support from experienced experts who understand plan benefits. Our goal is to find common ground, minimize delays, and help payers and providers reach mutually agreeable pricing. If Zelis is listed on your EOP, reach out – we’re here to help.

For NSA-eligible claims, our pricing recommendations follow federal guidelines. This typically means referencing the Qualifying Payment Amount (QPA), which is a median in-network rate used to determine fair reimbursement. Some of our payer clients use their own QPA while others leverage Zelis’ QPA to price their claims as we are a qualified third-party eligible .

We offer hands-on support from experienced experts who understand the NSA regulations and how to apply plan benefits. Our goal is to find common ground, minimize delays, and help payers and providers reach mutually agreeable pricing. If Zelis is listed on your EOP, reach out – we’re here to help.

If your service qualifies under the NSA and you disagree with the reimbursement offered, you may be able to initiate a dispute via the federal arbitration process. The payer’s EOP should include information on how to do this.

Start with the contact information listed on your EOP or remittance statement. If Zelis supported the claim, our service team is available to answer questions, explain our role, and direct you to the right party for support.