Gain claims pricing accuracy and transparency with Zelis.

Price claims and compare provider rates across regions with a clear expectation of costs and deeper insights into claim pricing and processing and network performance. 

Why Zelis?

Track the path of every claim with a fully transparent process trail.

In-Network Pricing and Contract Modeling is a highly configurable, all-in-one claim pricing solution that leverages cutting-edge technology to analyze plans, measure contract performance, and price claims with accuracy and transparency.

Key Points

  • <1 second to reprice a claim
  • 82M+ claims repriced in 2023
  • 99% auto adjudication rate
  • Robust reporting & in-depth contract analysis
  • API, EDI, or portal integration to make repricing claims easier
  • Ability to load contracts on your behalf!

In-Network Pricing and Contract Modeling

Automate claims pricing & strengthen provider contracting negotiations

Minimize claim pass-through frustration by viewing exactly which edits were applied prior to payment. Our process trail provides full transparency on how claims are priced, showing the work behind specific formulas and edit logic applied at the claim and line level. 

Forecast the impact of contract updates during provider negotiations by benchmarking provider rates to Medicare or other network contracts. When updating contracts or considering plan changes, predictive plan and rate analytics provide the actionable insights needed to measure the financial impact and make smarter decisions. 

Leverage our source pricers for all direct agreements, including Medicare, Medicaid, commercial, and other government programs. We’ll load and maintain client contracts & fee schedules, manage the contract inventory, and price claims against them for all plan types.  

Our pricing team even employs real-time CMS and state edit and compliance updates to ensure our pricing methodologies are always current.  

In-Network Pricing
How it works

Fast, flexible, and robust service & technology

Eliminate the confusion in healthcare and harness leading technology from a team committed to providing a fast implementation time and customizing solutions to meet your needs. We’ll even load contracts for you!

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Let’s talk about modernizing your business.

There’s no shortage of ways we can help. Get a conversation going with one of our Solution Advisors and build a thoughtful approach aligned to your business goals.

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