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Reference-Based Pricing for Network Replacement

Set limits on rising healthcare costs.

Referenced Based Pricing Table

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.

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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


Reference-Based Pricing in action.

Take the Next Step

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

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