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Solutions / Out-of-Network Solutions / Market-Based Pricing
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Market-Based Pricing

Customized to meet plan goals and provide security even when a discount is not contracted.

Talk to us about Market-Based Pricing
Market Based Pricing Table

Create a single-point solution for cost containment and compliance.

At Zelis, we take a different approach to market-based pricing. Rather than relying on one source – such as calculating 120 or 300% of Medicare allowable charges – we take a broader approach.

We use multiple sources to derive fair and defensible reimbursements that reflect the market you compete in, including commercial reimbursements, geographic specificity, procedure and provider details, and our propriety intelligence.

From there, we make specific adjustments based on your individual plan and preferences, resulting in a more member- and provider-friendly, sustainable savings model.

As the market shifts, so does our approach, so your pricing strategy will always be in line with the market. For example, Zelis is enhancing our market-based pricing with median in-network rates to address requirements of the No Surprises Act.

Our goal is not simply to drive you toward the lowest possible price, but to create a sustainable solution that works for all, with as little friction as possible.

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For Payers

Zelis Market-Based Pricing allows you to:

  • Achieve sustainable savings
  • Match pricing and savings to real-world market conditions
  • Drive optimal savings balanced with provider acceptance
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Zelis by the Numbers

Measurable negotiated savings:

95 %
savings retention
< 10 %
inquiry rate

Testimonials

Market-Based Pricing in action.

“As we look to get our clients to their lowest cost medical spend, we feel Zelis is a vital partner in that regard by providing their knowledge, technology, and services. Their combination of services – editing, negotiations, network, ERS and electronic payments – all with one business partner leads to cost savings for clients and efficiency of operations leading to reduced operational costs.”

– Steve, COO of TPA

“We’re the nation’s largest Taft Hartley TPA, and have been working with our partner Zelis for the past several years. Our clients have enjoyed average savings of 42% off charges. As a result, they’ve returned tens of millions to their trust funds, benefiting their members while reducing member liabilities. No other product or service we’ve partnered with has had the impact of Zelis.”

– Craig, COO of TPA

“Working with Zelis has helped us take an end-to-end approach to that problem starting with pre-payment, looking at the best way to pay those claims initially to get the best pricing available. Through the end- to-end continuum that Zelis offers we have an opportunity to work with them from pre-payment through to payment.”

– Todd, Manager of Regional Health Plan

Take the Next Step

Learn how Zelis Market-Based Pricing drives sustainable savings.

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