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Out-of-Network Solutions
Use a balanced, flexible approach to out-of-network savings.
Out-of-Network Solutions
Gain control over the rising cost of out-of-network claims.
- Balance savings with provider acceptance
- Put key savings opportunities to work
- Set savings goals and parameters based on plan or company guidelines and tolerance
- Leverage clinical, technical and regulatory insights
- Leverage a dynamic optimization engine with customizable rules to automatically route claims to the best savings channel
- Stay ahead of evolving surprise billing and cost transparency regulations
Claims Negotiations
Achieve pre- and post-payment savings through provider relationships, coding expertise and historical benchmarks.
Market-Based Pricing
Maximize acceptance and minimize appeals with a pricing strategy that improves transparency, reduces provider abrasion and drives savings.
Specialty Networks
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.
Testimonials
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
Case Study
Third-Party Administrator ACS Benefit Services realizes $13M in Savings
By choosing to add Zelis as their external partner for healthcare bill reviews, edits, and audits, ACS has converted more than 300,000 paper payments to electronic modalities and realized $13M in gross savings since 2018.
Take the Next Step
See the difference our balanced approach will make with your out-of-network claims.
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