Products / Specialty / Reference-Based Pricing Networks
Zelis
Public factsPayments, networks, and reference-based pricing platform
Healthcare payments and pricing platform for payers and TPAs, including network design, claims pricing, Open Access Pricing RBP, and provider payments.
Overview
Zelis sells a connected healthcare-finance platform: build/manage networks, engage members, optimize claims, send payments, and orchestrate communications. The homepage says Zelis works on behalf of more than 725 insurers nationwide. After acquiring Payer Compass in September 2022, Zelis markets reference-based pricing as Open Access Pricing®, with Compass Connect (member app), Broker Connect, Open Access Providers℠ direct agreements, and legal support via Southern Health Lawyers, LLC. Named platform pieces include Network360®. Zelis is broader than RBP; this page sits in the specialty/RBP category because networks and Open Access Pricing are core buyer use cases.
Why it matters Zelis is the scaled payments-and-pricing utility behind many TPA networks and, after Payer Compass, a primary commercial RBP platform.
- Target buyer
- Health plans, TPAs, and self-insured employers (often via TPA) buying networks, claim pricing, RBP, or payment operations.
- Pricing model
- Not published; platform / network / RBP contract
- RBP page vendor stats: 2MM+ RBP claims repriced annually, 60,000+ EE lives, 97% retained savings, <4% member and provider inquiry rate, 25 years’ negotiation experience. No PEPM list.
- Availability
- National
- Research
- Last researched 2026-08-23
- Public facts category
Key features
- Network design, assessment, and maintenance
- Open Access Pricing RBP (maximums from pre-defined reference prices)
- Compass Connect member app for provider price and quality shopping
- Zelis Open Access Providers direct agreements (PCP, clinics, hospitals, labs, specialties)
- Member advocacy: pre-service outreach, provider education, balance-bill resolution, legal escalation
- Broker Connect tool to search RBP-accepting providers
- Claims pricing with real-time edits and contract loading
- Network360 and payer/provider payment portals
Integrations
- 725+ insurer / payer clients (homepage)
- EDI connections (payer testimonial language)
- Payer Compass Visium (still listed on Zelis client login)
- Payspan and ZAPP payment portals (login directory)
- Southern Health Lawyers, LLC for plan-document review and litigation representation
Overview
Zelis describes five platform capabilities: build better networks, engage members, optimize claims management, send payments, and orchestrate communications. It is a payments and pricing company, not a health insurer. The homepage states work on behalf of more than 725 insurers and highlights Network360®.
Reference-based pricing is sold as Zelis Open Access Pricing®: the plan sets maximum reimbursement amounts using pre-defined prices rather than a traditional PPO contract. Zelis says it prices claims to the plan’s parameters; it does not underwrite medical risk.
Key Capabilities
- Network build and management for payers/TPAs.
- Open Access Pricing: technology to load contracts, apply edits and regulatory updates, and reprice medical claims.
- Customizable member advocacy (pre-service outreach, provider education, contracting support, balance-bill resolution, legal escalation, litigation representation).
- Compass Connect: find/compare providers by location, specialty, and service with cost and quality data.
- Broker Connect: free broker tool to search providers by location, RBP acceptance, and specialty.
- Open Access Providers℠ direct agreements to expand RBP-accepting access and reduce abrasion.
- Payment integrity and electronic provider payments (separate portals on the login page).
RBP page figures (vendor-stated): 2 million+ RBP claims repriced annually, 60,000+ employee lives, 97% retained savings, under 4% inquiry rate, 25 years of provider negotiation/contracting/settlement.
Integrations & Ecosystem
Payer clients include national plans, Blues, regional plans, TPAs, and self-insured employers (2022 close-era “About Zelis” language cited 700+ payers including the top-five nationals). Login roster still names Payer Compass – Visium under Claim Pricing, plus Payspan and ZAPP. Legal partner named for RBP: Southern Health Lawyers, LLC.
Pricing
Not published. Sold as enterprise network, pricing, and payment contracts.
Notes & Limitations
- Zelis is a service partner; benefit design, balance-bill rules, and prior auth remain with the TPA/plan.
- RBP FAQ states providers may not get advance notice because there is no traditional network agreement.
- See the Payer Compass page for pre-2022 lineage.
Sources
Tags: RBP · networks · claims pricing · payments · Open Access Pricing