Zelis® Launches AI-Native Solution to Help Payers Address Rising IDR Challenges

Unified No Surprises Act workflow helps payers reduce avoidable escalations, manage deadlines and improve visibility across the dispute lifecycle

News Summary:

• Zelis NSA Claim Advantage^℠ uses AI to automate payers’ workflows – from claim repricing and expert negotiation through IDR resolution.
• The solution builds on Zelis’ proven NSA performance, including processing $2.39 billion in NSA claim savings in 2025 with only approximately 8% of claims escalated to IDR.
• Built for a changing Federal IDR environment, Zelis NSA Claim Advantage^℠ supports evolving requirements, including changing deadlines, reporting obligations and process complexity under the NSA.

BOSTON--(BUSINESS WIRE)--Zelis^®, a leading provider of healthcare technology solutions, today announces Zelis NSA Claim Advantage^℠, an AI-native solution designed to help health insurance payers manage rising Independent Dispute Resolution (IDR) complexity under the No Surprises Act (NSA). As dispute volume, compliance requirements and process deadlines pressure payer operations, Zelis NSA Claim Advantage brings automation, predictive intelligence and embedded expert validation into a unified workflow spanning claim repricing, open negotiation, dispute prevention, case management and IDR resolution.

The launch comes as payers prepare their operations to manage the June 2026 Federal IDR final rule, which introduces new communication, open negotiation, eligibility, batching and process requirements designed to reduce ineligible disputes and improve efficiency across the federal dispute resolution process.

"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.”

Helping Payers Gain Control and Visibility
Zelis NSA Claim Advantage automates workflows and reduces operational blind spots across the IDR process, helping streamline out-of-network claims processing. The solution enables payers to move from manual, fragmented dispute management to a more strategic, data-driven operating model, contributing to more predictable dispute performance outcomes. With human-led, agent-accelerated operations, Zelis is helping payers reduce IDR cost exposure and eliminate operational risk by:

• Navigating NSA regulatory complexity with a highly automated and configurable design that can rapidly adapt to changing policy developments.
• Prevent deadline-driven losses using automated intake, documentation, alerts and escalation workflows to ensure cases progress on time - reducing the risk of missed deadlines, unnecessary fees and avoidable financial leakage.
• Defending every decision with real-time dashboards, Qualified Payment Amount (QPA) comparison analytics, full communication audit trails and evidence-based pricing recommendations to help payers explain outcomes, validate savings and support data-driven decision-making.
• Reducing avoidable IDR filings and improving dispute outcomes using predictive intelligence that creates customized case submissions, challenges non-qualifying disputes and surfaces Independent Dispute Resolution Entity (IDRE) behavior and provider patterns to optimize settlement strategies and drive stronger performance.

Why It Matters for Payers
IDR dispute volume has outpaced federal forecasts since the NSA took effect in 2021. Meeting deadlines and reporting requirements is an operational challenge for payers.

Managing the NSA lifecycle as rules continue to evolve through disconnected tools and manual workflows is no longer tenable. As a result, payers need a unified, automated system, such as the Zelis NSA Claim Advantage that prices accurately, resolves disputes efficiently, and prevents avoidable disputes from reaching IDR.

The Zelis Advantage
Zelis NSA Claim Advantage joins a host of claims optimization solutions, including payment integrity, in-network and out-of-network claim pricing. As a result, payers can create a unified and automated end-to-end claims management system – helping payers easily scale and adapt to meet changing operational and regulatory requirements.

Zelis uses AI and automation to accelerate case orchestration, surface patterns and recommend defensible IDR offer strategies, while expert teams remain embedded in the review process, negotiation strategy and case exception handling.

Zelis NSA Claim Advantage is now available to payers. To learn more about managing NSA workflows, go to: No Surprises Act with Zelis^®.

Additional Resources

• NSA IDR process explained
• Zelis’ 2025 CMS IDR Performance

About Zelis
Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top 5 national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients. Learn more at Zelis.com and follow us on LinkedIn to get the latest news.