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Reference-Based Pricing for Network Replacement

Set limits on rising healthcare costs.

Stabilize claims costs and improve provider accountability.

Traditional healthcare costs continue to run rampant with provider pricing variability. Payers need new strategies to stabilize claims costs and improve provider accountability around rising and variable fees.

Zelis’ Reference Based Pricing (RBP) Network Replacement sets maximum reimbursement amounts using pre-defined prices, providing a controlled savings model that gives members more control over their healthcare provider choices.

Customizable Solution

Payers need to meet a variety of unique employer needs, so we’ve designed a variety of network replacement options to meet them. Zelis’ RBP Network Replacement solution includes out-of-network savings, full network replacement, narrow networks, and custom network build options.

Comprehensive Support

Zelis support helps mitigate the risk of balance billing and improve member satisfaction. Clients can expand their RBP implementation beyond the core components with a range of options designed to advocate for members, improve transparency, manage risk and drive savings.

What sets Zelis apart:

2MM+ RBP claims repriced annually
60,000+ network replacement EE lives
97% retained savings
<4% member and provider inquiry rate
25 years’ experience with provider negotiation, contracting and settlement
15 years providing RBP solutions

Testimonials

Reference-Based Pricing in action.

“As we look to get our clients to their lowest cost medical spend, we feel Zelis is a vital partner in providing their knowledge, technology, and services. Their combination of services – editing, negotiations, network, ERS and electronic payments – all with one business partner leads to cost savings for clients and efficiency of operations leading to reduced operational costs for us.”

– Steve, COO of TPA

“They have excelled at finding large dollar overpayments that have enabled us to exceed our goals.”

– Angela, Manager at National Health Plan

“Our total savings for clients in just the past year topped $4.1 million resulting in $24.98 PEPM savings. One of the reasons is that Zelis has the ability to customize edits for their clients’ needs, for individual clients, services and even down to the provider level. Being able to customize a solution specifically for a client goes a long way in showing the value in our partnership with Zelis.”

– Mary, COO of TPA

Take the Next Step

It’s time for a network replacement that fits your unique needs.

Connect with Zelis