Claims Negotiations with Zelis

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

Dive Deeper

Achieve reasonable and transparent reimbursement.

We use advanced technology to identify claims that require negotiation, averaging 65% savings from claim negotiations. 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.

Features and Benefits

Leverage financial and clinical expertise to secure maximum savings.

Focus on clinical edits to begin negotiations with diagnosis code triggers.

Make financial arrangements based on member needs on a single claim or episodic care.

Attain sustainable, defensible savings with a letter of agreement documenting clinical findings and billing codes for all settled claims.

These types of claims are typically very expensive, so we worked with Zelis to find as much savings as possible on a claim-by-claim basis, and in doing so have achieved impressive savings on an annual basis.
The kind of longevity of Zelis team members can’t be overstated in this industry. So many at Zelis have been here as we faced challenging times, as well as during the many accomplishments we’ve achieved, and one of those was early in 2022 when we reached the milestone of administering benefits for over one million lives.

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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.

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