Zelis® Launches Reference-Based Pricing Solution

Solution will address fragmented healthcare cost containment offerings for self-insured employers while freeing members from network limitations

Zelis, a healthcare technology company modernizing the healthcare financial experience for all, today announced the launch of its new open access pricing solution. Self-funded employers, which represent 65% of U.S. workers, often struggle to sustain the cost of traditional health plan premiums, and existing solutions are often fragmented and have not delivered a satisfactory experience for members in accessing and navigating care.

To overcome these challenges, third-party administrators need to bring alternative strategies to stabilize claims costs, improve provider accountability related to rising fees, and free patients from network limitations.

Zelis Open Access Pricing is a reference-based pricing (RBP) solution that empowers self-insured employers and third-party administrators to put their members’ experience first while also stabilizing rising healthcare costs.

The new solution allows clients to set maximum reimbursement amounts using pre-defined prices which allows for more predictable cost forecasting. At the same time, Zelis Open Access Pricing employs a member advocacy team that provides pre-service member education, navigation support, provider contracting support, balance bill resolution, and legal escalation support to ensure seamless interactions among payers, providers, and members. The technology-enabled solution includes modeling and analytics, contract management, and performance reporting, as well as a price and provider transparency application to drive member adoption.

“By combining Payer Compass with Zelis, we have joined advanced technology and best-in-class approaches to create this RBP solution to managing rising healthcare claims costs for clients and their members,” said Amanda Eisel, Zelis CEO.

Zelis Open Access Pricing gives members the freedom to choose their preferred healthcare providers, and offers fair, established pricing benchmarks that keep medical expenses under control.

“TPAs and self-funded groups want reference-based pricing for lower claims costs, configurable options, more predictable healthcare cost forecasting, and more,” said Rick Ellsworth, SVP, GM Payer Compass at Zelis. “We are excited to bring to market a fully integrated solution that fits their needs and enhances the experience for their members.”

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