Solutions / Out-of-Network Solutions / Claims Negotiations
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Claims Negotiations

Experienced pre-payment negotiators and post-payment claim settlement.

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Achieve reasonable and transparent reimbursement.

Our skilled negotiators, clinical and coding experts work collaboratively to optimize appropriate out-of-network reimbursement, pre- and post-payment, while maintaining strong relationships with your providers.

We used advanced technology to identify claims that require negotiation. It’s a clinically focused approach that looks at factors including medical necessity and experimental or investigational therapies.

While some claims may be negotiated automatically, others are routed to our skilled and tenured team. Their deep clinical and financial expertise leads to real savings – without violating PPO contracts. All negotiations result in a letter of agreement, including both clinical and coding findings.

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Diagnosis Code Triggers

Focus on clinical edits to begin negotiations.

Single Claim or Episodic Care

Make financial arrangements based on member needs.

Sustainable, Defensible Savings

All negotiations result in a letter of agreement documenting clinical findings and billing codes.

For Payers

Zelis Claims Negotiations enables you to:

  • Leverage financial and clinical expertise to secure maximum savings
  • Maintain strong provider relationships
  • Document negotiations for members and providers
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Zelis by the Numbers

Measurable negotiated savings:

65 %+
average savings from claim negotiations

Take the Next Step

Learn how Zelis Claims Negotiations can drive savings for your plan.

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