Zelis, a healthcare technology company, introduced an artificial intelligence platform to assist health plans with the Independent Dispute Resolution process. This federal framework, established by the No Surprises Act in 2020, governs the adjudication of out-of-network medical claims. The software deployment targets payer operations facing pressure from dispute volumes, process deadlines and compliance requirements.
The application utilizes artificial intelligence to automate multiple stages of the payer workflow. The system manages claim repricing and open negotiation while integrating features for dispute prevention, case management and final resolution. Executives at the company stated the tool helps organizations navigate the complexity of the arbitration cycle.
The product release follows regulatory updates finalized in late May by the Centers for Medicare and Medicaid Services. The revised regulations, issued in coordination with the Office of Personnel Management and the Departments of Health and Human Services, Labor and Treasury, implement new operational standards. The final rule introduces batching and eligibility parameters alongside new open negotiation and communication requirements. Federal agencies designed these additions to improve process efficiency and reduce ineligible disputes.
The federal update also lowers the administrative fees associated with disputes from $115 to $15. The agencies argued this fee reduction will make participation easier while maintaining a self-sustaining program.
