PROVIDER FREQUENTLY ASKED QUESTIONS
How can I become a Participating Provider with a HealthSmart PPO Network?

You can request an application by either contacting our Customer Service Department at 866-511-4757 or requesting an application on our website.

Can I obtain a listing of Client/Payors in my area?

Yes. Please contact our Customer Service Department at 866-511-4757 or CLICK HERE to see a list of clients.

Where do I send claims?

Mail claims to the address listed on the Member ID Card.

How do I appeal the way a claim was paid?

Contact the payor to verify the claim was paid in accordance with plan benefits. If upon contacting the payor, you still believe the claim was processed in error, please contact our Customer Service Department at 866-511-4757 for instructions on how to appeal the claim.

How do I identify a patient as a member of one of the HealthSmart PPO networks?

We make every effort to identify participating PPO members. Most members have a Member ID card that contains the PPO's name. If there isn’t a member ID card available, please contact the Customer Service Department at 866-511-4757 for further assistance.

How do I verify benefits?

Please contact the payor listed on the Member ID card for benefit information.

My state has a standard application form; will you accept the form in lieu of completing your provider application form?

Yes

What labs can I refer members to?

Please verify with our Customer Service Department at 866-511-4757 to verify what labs are participating in the network.

What other providers are in my area?

This can be found by visiting our online provider directory.

Do I get a provider number or billing number once I’ve been credentialed and accepted into the network?

No. Upon acceptance as a participating provider in the network, you will receive a welcome letter and information stating your effective date within the network.

I am leaving my provider group but would like to retain my membership in one of the HealthSmart provider networks. What should I do?

Please contact our Customer Service Department at 866-511-4757 to request a provider application packet.

How do I obtain a copy of my contract with one of your PPO networks?

Please contact our Customer Service Department at 866-511-4757 to request a copy of your network contract.

What products and services do you offer?

Please CLICK HERE to read more on our services to read more on our services or contact our Customer Service Department at 866-511-4757.

How do I determine what products I participate through one of your provider networks?

Please contact our Customer Service Department at 866-511-4757 to obtain information on your product participation.