Zelis In-Network Pricing and Contract Modeling is an advanced solution designed to streamline the pricing of in-network claims and improve provider contracting processes. By leveraging cutting-edge technology, it analyzes plans, measures contract performance, and prices claims with precision and transparency. This solution enables health plans to reprice claims in less than a second, achieving a 99% auto adjudication rate and processing over 82 million claims in 2023. It offers robust reporting and in-depth contract analysis, with integration options via API, EDI, or portal to facilitate seamless claim repricing. Additionally, Zelis can load contracts on behalf of clients, ensuring a comprehensive and efficient pricing process. Key Features & Benefits

• Line-by-Line Claim Process Trail Provides full transparency on claim pricing by detailing the edits applied at the claim and line level, reducing pass-through frustrations.
• Benchmark Modeling & Disruption Analysis Allows health plans to forecast the financial impact of contract updates during provider negotiations by benchmarking provider rates to Medicare or other network contracts.
• Advanced Claim Pricing Methodologies Utilizes source pricers for all direct agreements, including Medicare, Medicaid, commercial, and other government programs, to ensure accurate and defensible pricing.
• High-Speed Repricing Enables the repricing of claims in less than a second, enhancing operational efficiency.
• Robust Reporting & Analysis Offers comprehensive reporting and in-depth contract analysis to support informed decision-making.