Gain control of claim cost with Zelis.
Use a balanced, flexible approach to out-of-network savings.
Why Zelis?
A powerful way to manage the rising cost of out-of-network claims.
Gain control over the rising cost of out-of-network claims with a dynamic optimization engine with customizable rules to automatically route claims to the best savings channel.
Key Points
- Balance savings with provider acceptance.
- Put key savings opportunities to work.
- Set savings goals and parameters based on plan or company guidelines and tolerance.
- Set savings goals and parameters based on plan or company guidelines and tolerance.
- Leverage clinical, technical, and regulatory insights.
- Stay ahead of evolving surprise billing and cost transparency regulations.
- Leverage a dynamic optimization engine with customizable rules to automatically route claims to the best savings channel.
Out-of-Network Solution Suite
Optimize your financial performance while balancing risk.
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.
Ensure adequate coverage for out-of-area, out-of-network and other key providers through access to a wide variety of local, regional, and national specialty medical, dental, and worker’s compensation networks, which can be combined with your own provider network.
- Expand the discounts available to plans and members, delivering both convenience and savings.
- Avoid contract breaches that often exist with competitors’ supplemental networks.
- Fill coverage gaps with niche networks focused on specialty providers including behavioral health, OT, PT and chiropractic care.
- Applying in or out-of-network benefit levels flexibly based on your needs.
- Reduce plan and member costs with shared savings model.
Gain the insight and tools you need to comply with federal balance billing and transparency regulations.
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Achieve your optimal balance between savings and abrasion.
Our optimization engine uses a combination of proven saving channels to find the best one for every claim, including NSA claims, integrating with core adjudication platforms.
Request a Meeting
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.