Streamline payments. Expand patient reach. Grow with Zelis®.
Zelis empowers providers to simplify payments, reach more
patients through network contracts, and overcome out-of-network challenges—clearing hurdles so care flows freely.
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Simplify Healthcare Payments with Zelis
Consolidate electronic payments and remittance streams
from 550+ payers in a single platform.
With Zelis, you can get paid faster and streamline your payments workflows with access to all Zelis payers from one portal—reducing AR days, and giving time back to your team.
See how providers use our healthcare payments solutions to simplify payments, improve cash flow, and drive team efficiency without the hassle.
Grow Your Practice with
Zelis Networks
Join one of the nation’s fastest growing provider networks,
connecting you to more than 750 payers and 100 million patients
actively seeking in-network care.
Our contracting approach offers competitive fee schedules,
accurate and timely reimbursements, and streamlined enrollment.
With Zelis, you gain visibility in payer directories, negotiation
leverage with payers, and dedicated support. Discover how our
payer connections and supportive service model can help you
grow your practice.
Helping Providers Understand Out-of-Network Claim Pricing with Zelis
We get it—out-of-network claims can be confusing. If you’re here, it’s likely because you’ve received a payment—or pricing information—from a third-party administrator or health plan we support. Zelis partners with health plans to deliver accurate, market-based pricing for out-of-network claims.
We know it can be frustrating to see a claim priced by a company you’ve never worked with directly. We’re here to answer your questions, clarify our role, and help make this process as fair and transparent as possible—for you, your patient, and the payer. We support a process that promotes affordability for members, fairness for providers, and sustainability for payers.
Frequently Asked Questions about Zelis Out-of-Network Pricing from Providers
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 fair market 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 using the contact information listed – 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 database.
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 using the contact information listed – 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.
We support our clients throughout the independent dispute resolution (IDR) process and offer provider support to explain how the pricing was determined to help you decide your next step. We’re committed to a professional and respectful experience.
It’s important to note that while Zelis does support NSA arbitration, we are not the payer and are not responsible for payments or independent dispute resolution entity (IDRE) administrative fees.
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.