Use a balanced, flexible approach to out-of-network savings.
Gain control over the rising cost of out-of-network claims.
Achieve pre- and post-payment savings through provider relationships, coding expertise and historical benchmarks.
Maximize acceptance and minimize appeals with a pricing strategy that improves transparency, reduces provider abrasion and drives savings.
Reduce plan and network costs with coverage for specialty providers including behavioral health, OT, PT and chiropractic care.
No Surprises Act / Transparency in Coverage
Gain the insight and tools you need to comply with new balance billing and transparency regulations set to take effect beginning in 2022.
Market-Based Pricing in action.
“Our partnership with Zelis as a vendor is one of the most flexible of any we have. Zelis is very proactive in finding new ways of cost savings for our clients and always have the interest of their clients in mind. We’ve never heard, “we can’t do that.” We always hear that Zelis will see what they can do to help.”
– Deena, COO of TPA
“As a regional health plan, we face challenges with serving our local communities and having an understanding of what is happening on a national level. Working with Zelis helps us tackle that problem. They have knowledge beyond our region, and they help bring that information to us so that we can make smarter strategic decisions.”
– Todd, Manager at Regional Health Plan
“One benefit of working with Zelis is their flexibility to meet our ever-changing needs. Our TPA is geographically located in a very demanding “provider hotbed” so we experience excessive pushback and nonconformity which Zelis continues to put forward unique options and opportunities to allow collaborative efforts to manage the high cost of services in our member’s complex medical care market.”
– Cindy, COO of TPA