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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How It Works
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.
Our relationship with Zelis has given us the flexibility to create customized solutions and bring value to our clients. The solutions and expertise that Zelis brings to the table, as well as its team’s ability to develop ideas to improve our processes, have created a mutually beneficial relationship for both our companies.
Zelis listens to our business needs and growth strategy, and anticipate how ACS can continue to deliver results for our clients. We have a comprehensive partnership across many different solutions, and we are continuing to expand.
Zelis has always given us the tools we needed to succeed. Working with their team has helped us navigate the constantly changing demands of the market that are generated by our clients’ needs, regulatory issues, and the passage of new legislation. We have a level of confidence that when something new comes up, we’re going to work with Zelis to solve the problem.
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.