With Zelis Price Map, you can unlock healthcare pricing transparency for Medicare hospitals by using aggregated CMS data to benchmark your plan’s Medicare reimbursement rate to the facility’s actual amount.
Use the map’s colored pins to see drilled-down details on specific facility, provider, and inpatient/outpatient claim reimbursement. This data can help you identify opportunities to effectively incorporate alternative plan models such as Reference Based Pricing or Provider Direct Contracting.
Our Price Map can help you benchmark your plan’s Medicare reimbursement rate to the facility’s actual amount, identify potentially hostile environments for payers, and find regions where alternative plan models can thrive, like reference based pricing or provider direct contracting.
These maps show the overall ratios of charges to actual Medicare payment for all Medicare-certified hospitals across the United States. The data is based on the top 100 MS-DRGs and top 30 APCs.
Select the colored pin in the geographic area of interest to view the following:
PLEASE NOTE: The maps incorporate data directly obtained from CMS. CMS’s release schedule of this information is approximately two years in arrears, i.e. the Price Map titled 2022 CMS Release represents data from 2020 but was posted publicly on CMS.gov in 2022.
“Zelis makes doing business simple. Our clients are saving so much money on claims that they're asking for new products. It's a rare treat to sit down with a client that hasn't bought a new solution in years and is now asking "what's next?" That builds loyalty.”– Craig, COO of TPA
“The implementation process with Zelis was painless. Their team assisted us in making sure that all the details were handled, and that all our business was moved and active in the systems within 90 days from implementation.”– Joanne, Vice President of TPA