Zelis NSA Claim Advantage has launched as an AI-native healthcare technology solution designed to help payers manage growing Independent Dispute Resolution (IDR) challenges under the No Surprises Act (NSA). The solution enables health insurance payers to simplify dispute workflows, improve visibility, and reduce operational pressure. Zelis, a leading provider of healthcare technology solutions, introduced Zelis NSA Claim Advantage to support payers facing increasing dispute volumes and regulatory requirements. The platform combines artificial intelligence, predictive intelligence, and expert validation within one unified workflow.
The solution manages multiple stages of the dispute lifecycle. These include claim repricing, open negotiation, dispute prevention, case management, and IDR resolution. As a result, payers can improve efficiency while reducing avoidable escalations. Furthermore, Zelis NSA Claim Advantage builds on the company’s proven NSA performance. In 2025, Zelis processed $2.39 billion in NSA claim savings. Additionally, only approximately 8% of claims moved forward to IDR escalation.
Zelis Helps Payers Navigate Changing NSA Requirements
The launch arrives as payers prepare for the June 2026 Federal IDR final rule. The updated regulation introduces new requirements related to communication, open negotiation, eligibility, batching, and dispute processes. Therefore, payers must improve their operational systems to manage increasing compliance demands. Zelis NSA Claim Advantage supports these changing requirements through automated workflows and adaptable technology.
“Rule changes by CMS and HHS have improved the efficiency and long-term sustainability of the NSA, but payers are overwhelmed by complexity and costs associated with the IDR process,” said Jim Bridges, President, Price Optimization at Zelis. “Zelis NSA Claim Advantage gives payers a smarter way to manage the IDR lifecycle. It combines AI-native automation, data-driven intelligence and human review across every step in the journey to identify risks earlier, reduce avoidable disputes and replace the guesswork with predictable outcomes.”
The platform allows payers to move from manual dispute processes to a data-driven operating model. It also allows organizations to achieve more predictable outcomes in disputes. Zelis NSA Claim Advantage automates intake, documentation tracking, alerts and escalation workflow. These capabilities help to prevent missed deadlines, unnecessary fees and financial losses.
AI Improves IDR Decision-Making and Claims Management
The solution also includes real-time dashboards and Qualified Payment Amount (QPA) comparison analytics. So payers have a better understanding of pricing decisions and dispute outcomes. Communication audit trails and evidence-based pricing recommendations that payers can support stronger decision making . They are also better at checking savings and explaining payment results. Zelis NSA Claim Advantage uses predictive intelligence to spot potential dispute risk. The platform enables users to file customized cases, contest non-qualifying disputes and analyze the behavior of Independent Dispute Resolution Entities (IDREs).
Also, the solution identifies provider patterns to help payers develop better settlement strategies. In this way organizations can improve their performance and reduce unnecessary IDR filings. Since the No Surprises Act went into effect in 2021, the federal volume of IDR disputes has been higher than expected. This means that payers are still facing challenges to meet deadlines and reporting requirements. It’s getting harder and harder to manage NSA requirements with disconnected tools and manual workflows. For payers, this means they need automated systems that can accurately price claims, efficiently resolve disputes and avoid unnecessary escalations.
Zelis to Enhance Healthcare Claims Optimization Capabilities Zelis NSA Claim Advantage is an addition to Zelis’ more comprehensive suite of claims optimization solutions. It offers payment integrity services, and in-network and out-of-network claim pricing solutions. This allows payers to establish an automated, end-to-end environment for claims management. They can also scale operations while adapting to evolving regulatory demands.
Zelis leverages AI technology and automation to accelerate case orchestration. The platform also finds patterns and suggests defensible IDR offer strategies. Simultaneously expert teams are working in all its phases. They offer support to review activities, negotiation strategies and complex case exception management. Zelis is leveraging technology and human expertise to help payers improve how they manage IDR. The company also continues its efforts to support healthcare organizations in meeting evolving regulatory and operational challenges through advanced solutions.
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News Source: Businesswire.com
