Market-based Pricing with Zelis.
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, more customizable approach.
Dive Deeper
A single point of contact for cost containment and compliance.
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 price recommendations 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. Our Established Reimbursement Solution® is enhanced 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 customizable, sustainable solution that recommends savings that work for all, with as little friction as possible.
By the Numbers
Measurable savings:
0
savings retention on claims priced with ERS
0
inquiry rate
As we look to get our clients to their lowest cost medical spend, we feel Zelis is a vital partner that provides their knowledge, technology, and services. Their combination of services – from editing, negotiations, network, and electronic payments – with one business partner leads to cost savings for clients and efficiency and reduced operational costs for us.
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%. As a result, they’ve returned tens of millions to their trust funds, which benefits members by reducing liabilities. No other product or service we have used has had the impact of Zelis.
Explore Further
Discover How Market-Based Pricing Can Transform Your Business
Let’s discuss how our innovative market-based pricing approach can modernize your healthcare cost management strategy. Our Solution Advisors are ready to explore tailored solutions that align with your unique business objectives and market dynamics.
During our meeting, we’ll:
Step 1
Review your current pricing challenges
Step 2
Demonstrate the benefits of market-based pricing
Step 3
Customize a strategy to optimize your healthcare spend
Step 4
Show how our data-driven approach can be adapted to meet local market conditions
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