Contract Modeling
Client-specific contract insights to improve plan performance and negotiations.
Zelis® In-Network Pricing Solutions
Accurate contracted claims. Complete transparency. Smarter negotiations.
Accuracy, Transparency and Control — All in One Place
Accurate contracted claim pricing
Price any contracted rate — commercial, Medicare, Medicaid, Tricare and more — in seconds.
Full process transparency
Process trails show exactly how each claim was priced, with line-level formula and edit logic.
Benchmark and contract modeling
Benchmark provider rates to Medicare, Medicaid, direct contracts, or in-network MRF data.
In-Network Pricing Products
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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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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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Explore All In-Network Pricing Resources
Healthcare Fraud, Waste and Abuse Guide
Learn what fraud, waste and abuse mean in healthcare, how to spot FWA indicators, and how payers can reduce improper payments with stronger payment integrity.
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.
