Zelis Open Access Pricing® is designed to help self-insured employers and third-party administrators manage rising healthcare costs while enhancing member experience. By establishing maximum reimbursement limits based on predefined benchmarks, such as a multiple of Medicare rates or average regional costs, this solution provides predictable cost forecasting and greater transparency. Members gain the freedom to choose their preferred healthcare providers without network restrictions, while payers benefit from stabilized claims costs. The program includes comprehensive member advocacy services, offering pre-service education, provider contracting support, balance bill resolution, and legal escalation to ensure seamless interactions among payers, providers, and members.

Key Features & Benefits

• Controlled Cost Management Implement predefined reimbursement rates to stabilize and predict healthcare expenses effectively.
• Enhanced Member Freedom Allow members to select their preferred healthcare providers without the limitations of traditional networks.
• Comprehensive Member Advocacy Offer robust support services, including pre-service education, provider negotiations, and balance bill resolution, ensuring a positive member experience.
• Transparent Pricing Benchmarks Utilize clear and established pricing references, such as Medicare rates, to promote fairness and clarity in medical service costs.
• Advanced Technology Integration Leverage technology to manage contracts, apply real-time edits, and process pricing efficiently, reducing administrative burdens.