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Solutions / Out-of-Network Solutions

Out-of-Network Solutions

Use a balanced, flexible approach to out-of-network savings.

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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
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Claims Negotiations

Achieve pre- and post-payment savings through provider relationships, coding expertise and historical benchmarks.

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Market-Based Pricing

Maximize acceptance and minimize appeals with a pricing strategy that improves transparency, reduces provider abrasion and drives savings.

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Specialty Networks

Reduce plan and network costs with coverage for specialty providers including behavioral health, OT, PT and chiropractic care.

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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.

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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