How One Payer Used Market-Based Pricing to Drive Out-of-Network Savings
See how a regional healthcare payer expanded ERS market-based pricing to grow out-of-network savings while keeping provider disputes low.
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Claims Editing with Zelis®
Tech-enabled expert-validated claims edits to prevent inaccurate payments.
Claims Editing Built Around Your Workflows
Growing library of edits
Continuously updated edits built on AMA, CMS, ICD-10 and other gold-standard clinical sources.
Clinical expert oversight
Recommendations are validated by a team of clinical and coding experts — not just rules.
Flexible workflow fit
Works as a first-, second- or third-pass editor to fit your existing claims processing workflow.
Customizable edit rules
Tailor edits to your plan policies, provider contracts and in-house guidelines — to the TIN level.
Sustainable savings
Low dispute and inquiry rates resulting in high savings defensibility and sustainability.
Reduced provider abrasion
Transparent logic with wrap around services to educate and engage providers on your behalf.
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Better Outcomes Before IDR: A TPA Case Study in NSA Performance
Explore how to use AI and automation improve healthcare claims management and how collaborating with experts can help.
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Proven Savings with SmartShopper
Discover the findings of the Wakely report, highlighting savings of $552 through SmartShopper participation and care transparency.
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Claims Editing Resources
2027 Maternity Coding Changes & Payer Readiness
Maternity care moves to phase-specific CPT reporting January 1, 2027. See how the 2027 maternity coding changes affect claims edits, benefits and analytics.
Healthcare Fraud, Waste and Abuse Guide
Learn what fraud, waste and abuse mean in healthcare, how to spot FWA indicators, and how payers can reduce improper payments with stronger payment integrity.
Reimagining P&C Claims Performance Webinar
Learn how P&C insurers can modernize medical payments, reduce manual work, accelerate claims workflows and improve claimant and provider experiences.
