Solutions / Network Solutions / Reference-Based Pricing for Network Replacement

Reference-Based Pricing for Network Replacement

A comprehensive savings strategy tailored to fit plan goals.

Unmatched flexibility and experience.

Zelis supports the payer’s ability to administer any iteration of Reference Based Pricing (RBP), whether for certain out-of-network claims only or as a full or partial network replacement.

Zelis RBP delivers a sustainable savings strategy through unmatched flexibility with pricing, network configuration and support services all tailored to meet unique plan needs.

Pricing Options

Unlike other RBP approaches, Zelis provides a choice of pricing options and guidance for the best pricing strategy.

Support Services for Sustainable RBP

Clients may choose to customize their Zelis RBP strategy with a range of innovative tools and services designed to advocate for members, improve transparency, manage risk and drive savings.

For Payers

What sets Zelis apart:

15-25% average year one plan savings
RBP guidance for smart provider lookup
95% retention rate
20+ years of experience with provider contracting and negotiation

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 better data.

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