Gain control of out-of-network costs with Zelis®
Use a balanced, customizable approach to out-of-network savings.
Why Zelis?
A powerful way to manage the rising cost of Out-of-Network claims.
Gain control over the rising cost of Out-of-Network (OON) claims with a dynamic optimization engine with customizable rules to automatically route claims to recommended quality savings channels.
Key Points
- Leverage AI-powered dynamic optimization engine to find quality recommended savings on every claim
- Balance savings with provider acceptance based on each plan’s unique goals and preferences
- Customize down to the individual employer group, service type, claim type, and individual member level
- Build trust and cooperation with providers at a local, regional and national level on out-of-network pricing efforts
- Integrate with numerous claims systems, including FACETS, to enables more efficient implementations and workflows
- Mitigate the impact of member abrasion and balance billing
Achieve your optimal balance between savings and abrasion.
Our AI-powered optimization engine uses dynamic routing to examine every available saving channel to drive valued savings.
OON Solution Suite
Optimize your financial performance while balancing risk.
Blend human expertise and advanced technology to deliver high quality savings by identifying the right claims for negotiation after services have been rendered.
Maximize acceptance and minimize appeals with a pricing solution that delivers defensible, geographically and adjusted pricing recommendations.
Apply contracted discounts to out-of-network claims leveraging Zelis networks and 60+ local, national, and specialty network partners. Gain access to 800k+ providers nationwide to expand coverage for out-of-network medical, dental, and worker’s compensation claims.
Price out-of-network claims consistent with federal and state-level regulations to help avoid state arbitration occurrences. Support includes pricing based on state-specific requirements, provider education, and post-payment provider negotiations according to state deadlines and processes.
Gain the insight and tools you need to comply with federal surprise billing regulations. Our legislative expertise informs a comprehensive approach to pricing, negotiations, IDR support, and transparency.
Transform your member experience with expert out-of-network balance bill navigation.
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average client tenure
Zelis listens to our business needs and growth strategy, and anticipate how ACS can continue to deliver results for our clients. We have a comprehensive partnership across many different solutions, and we are continuing to expand.
Zelis has always given us the tools we needed to succeed. Working with their team has helped us navigate the constantly changing demands of the market that are generated by our clients’ needs, regulatory issues, and the passage of new legislation. We have a level of confidence that when something new comes up, we’re going to work with Zelis to solve the problem.
Request a Meeting
Out-of-network challenges? Zelis has your back. Talk to a solution advisor today!
Don’t overpay for OON claims. Zelis negotiates fair rates, manages specialty networks, and facilitates No Surprises Act compliances. Contacts us today!