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Zelis Debuts In-Network Pricing Tool for Health Plans

Healthcare technology firm Zelis has introduced an in-network pricing/contract modeling service for health plans.

“The addition of this solution further solidifies the company’s position to help health plans understand and proactively navigate claim pricing, processing and financial impacts resulting from contract changes,” Zelis said in a news release Tuesday (March 26). 

“Rounding out the company’s full-service claim-pricing suite, health plans can now benefit from a comprehensive solution set that enhances precision and transparency in contract claim pricing and comparative modeling,” the release added. 

According to the release, the solution offers a “clear expectation of cost,” so that health plans can more accurately price contracted claims. It also provides access to Zelis’ library of pricing methodologies, letting health plans almost instantly price against any contracted rates, including commercial, Medicaid, Medicare, Tricare and other programs. 

“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,” he added. 

This has been a busy month for Zelis, which last week announced a collaboration with the real-time health network Availity. As reported here, the partnership covers everything from administrative workflows through payments.

Yusuf Qasim, president of payments optimization at Zelis, said in a news release that the alliance was “another step in the journey to make healthcare flow more seamlessly in this country, and we believe that Availity is the right partner to help make that happen with their unique footprint and strong client relationships.”

The month also saw the launch of SmartShopper Propel, Zelis’ new member engagement tool designed to improve healthcare experiences for members of various health plans.

SmartShopper Propel is aimed at helping individuals, including those covered under commercial insurance and Medicare and Medicaid plans, navigate the healthcare landscape more effectively while improving their satisfaction with their health plans.

“With SmartShopper Propel, we are not just presenting members with arbitrary options,” Heather Cox, president of insights and empowerment at Zelis, said in a statement. “We are partnering with health plans to help them reach their member activation goals by creating personalized engagement and incentives tailored to the unique needs of each member.”