No Surprises Act with Zelis.

Address the complex requirements introduced by federal regulations through highly configurable solutions, legislative expertise, and guidance from Zelis.

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Dive Deeper

Minimize the impact of new regulations.

The No Surprises Act (NSA), signed into law in December 2020, seeks to protect patients from surprise medical bills and prohibits balance billing for certain out-of-network care. The Transparency in Coverage Rule (TiC) was published in October 2020. Its transparency provisions empower consumers with better insight into the cost of services before obtaining care and receiving a bill.

Our suite of solutions helps you comply with these new regulations, improve your members’ experience, and maximize savings while minimizing provider abrasion. We provide legislative expertise and guidance to help plans manage the complexity introduced by both the NSA and the TiC Rule.

Features and Benefits

Go beyond compliance with new innovations to out-of-network claims.

Get enhanced market-based pricing with the ability to price according to median INN rates, accounting for the various factors that NSA prescribes such as acuity of patient and setting of care, reducing the risk of arbitration.

Address out-of-network (OON) MRF data requirements for Zelis-priced OON claims, or access in-network (INN) MRF data with median INN rates for clients whose primary networks are owned or managed by Zelis – and leverage creation, hosting, rates management, and analytics.

Price transparency that goes beyond meeting the mandates, giving healthcare consumers more control of their healthcare spending and rewarding them for making informed, more affordable decisions while meeting the TiC and NSA price transparency requirements.

Provide enhanced ID card capabilities to print compliant ID cards with additional required information including member deductible, out-of-pocket maximum, and information on where to find in-network providers.

Zelis Member Communications will publish compliant Advanced Explanation of Benefits (AEOBs), both print and digital, with the ability to handle increased volume.

Understand the impact of various pricing strategies and their likelihood of acceptance with a predictive model based on real-time IDR results. Get expert guidance and data, analytics, and reporting for negotiating IDRs with providers and incorporating market median data for NSA claims. Understand of the impact of various pricing strategies and their likelihood of acceptance with a predictive model based on real-time IDR results.

As we’ve worked with Zelis, we’ve found all their capabilities and solutions to be very easy to plug-in and integrate with our offerings. That flexibility is very valuable to us.
Joel
Joel, Executive Director of National Health Plan
From the start, Network360 has been a wildly successful program that has impacted our ability to meet goals and grow our business.
Bill Heidt
Bill Heidt, National Sales Executive, BRMS View case study
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.
Hilary Chapman
Hilary Chapman, Operations Manager of ValueHealth Benefit Administrators View case study

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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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