What You Should Know:
Zelis, a leader in healthcare technology solutions, has announced its newest weapon in the fight against opaque claim pricing: In-Network Pricing and Contract Modeling. This comprehensive solution empowers health plans to understand and manage claim pricing proactively, leading to more accurate cost estimates and improved financial control.
A Complete Claim Pricing Suite: Precision and Transparency
In-Network Pricing and Contract Modeling joins Zelis’ existing suite, offering a one-stop shop for all your claim pricing needs. This all-encompassing solution boasts several key benefits:
Clear Cost Expectations: Gain a precise understanding of claim costs before processing.
Automatic Pricing: Leverage a vast library of methodologies to price any claim in seconds.
Extensive Program Support: Handles commercial, Medicaid, Medicare, Tricare, and more.
Reduced Administrative Burden: Experts handle contract uploads and fee schedules.
Frictionless Provider Experience: Transparent line-by-line pricing formulas for providers.
Unique Features Drive Transparency for All
Unlike competitors, Zelis’ solution promotes collaboration between health plans and providers. Providers can access detailed pricing breakdowns, fostering trust and reducing the risk of balance billing. Additionally, payers can share this information with providers to ensure accurate pricing for all parties.
“We understand that navigating complex stakeholder relationships and evolving healthcare regulations requires more from a cost management partner than strictly managing cost,” said Jay Deady, President of Price Optimization for Zelis. “Platform solutions like this compound efficiencies, enhance the member experience, minimize payer-provider abrasion, and lower the overall cost of care for everyone involved.”
Partnership with Availity
Zelis announced a strategic alliance with Availity, the nation’s largest real-time health information network to streamline the entire financial experience, from claims processing to payments. The healthcare industry is notorious for its complex administrative processes, often leaving both payers and providers frustrated. Currently, navigating the healthcare financial system requires logging into multiple platforms and sifting through scattered information. This inefficiency not only wastes time but also creates confusion and errors.
Zelis and Availity’s partnership aims to solve this problem by combining their core functionalities. This will create a single, unified platform offering:
Turnkey enrollment and onboarding: Eliminate the hassle of complex onboarding processes.
Centralized access to payment and remittance data: Find everything you need in one place.
Real-time analytics and dashboards: Gain valuable insights into your financial performance.
Multiple disbursement options: Choose the payment method that best suits your needs.
“At Availity, we believe that patient-centric care starts with simplifying the administrative processes between payers and providers. Availity and Zelis, both trusted by payers and providers for digital connectivity, have identified ways to accelerate critical processes in the healthcare system,” shared Availity CEO, Russ Thomas. “This is a situation where two companies who play crucial roles in the administrative workflow and reimbursement process are coming together to join our core capabilities in a valuable way for our mutual clients, and it’s meaningful for reducing the administrative burden for the entire system by creating shared processes and shared value.”
