FREQUENTLY ASKED QUESTIONS

FAQs about HealthSmart's Network Integration and System Conversion

Who is HealthSmart?

HealthSmart is a managed healthcare company dedicated to providing comprehensive and innovative healthcare solutions to meet client needs. We offer an inventory of wholly-owned products and services:

  • HealthSmart Care Management Solutions, a full-service care management company
  • HealthSmart Rx, a full-service prescription benefit manager
  • HealthSmart Primary Care Clinics, which manages on-site employer-sponsored healthcare clinics
  • HealthSmart Information Systems, a healthcare IT provider with over 200 million EDI transactions
  • HealthSmart Provider Networks, PPO networks that encompass several directly-contracted provider networks such as HealthSmart ACCEL, HealthSmart Preferred Care II, LP (HSPC), Interplan Health Group, Inc. (IHG), Emerald Health Network, Inc. (EHN), Preferred Plan, Inc. (PPI) and HealthSmart Payors Organization (HPO).
What is HealthSmart Preferred Care?

The HealthSmart Preferred Care network is one of our wholly-owned nationwide primary preferred provider organizations. HealthSmart Preferred Care was formed in 1993. It began as a network with a significant presence in the Southwest region, and has now expanded across the country.

Why are you integrating three of your networks – Interplan Health Group, Emerald Health Network and Preferred Plan Inc. – into HealthSmart Preferred Care?

Over the years, HealthSmart has either built from the ground up or acquired several provider networks. Until recently, each network operated independently, which led to operational inefficiencies. The effort and expense of maintaining independent systems, processes and personnel kept us from offering our customers national network coverage under a common brand across the country. With this network integration, HealthSmart is utilizing a new state-of-the-art PPO platform system, reconfiguring our infrastructure and cross-training our support teams, all in an effort to offer a stronger, more efficient, more responsive network product to our customers. HealthSmart is very excited about the full implementation of this system and the high-level of service this and many other network initiatives will bring to our providers and clients.

Why are you using HealthSmart Preferred Care as the name of this integrated network?

We selected HealthSmart Preferred Care because HealthSmart founded the provider network, built it from the ground up and developed it over the last 18 years.

Will clients need to sign a new network access agreement with HealthSmart Preferred?

Due to the many acquisitions during the past several years, many of our clients have historical and multiple agreements with us. It is our goal to consolidate our client agreements under one standard HealthSmart contract agreement with each payor partner.

How will providers identify patients as members of the HealthSmart Preferred Care network?

Members using HealthSmart networks are issued Identification (ID) Cards. We requested that HealthSmart providers accept ID Cards displaying legacy logos through July 1, 2012 and to accept ID Cards with the new HealthSmart Preferred logo beginning July 1, 2011. As clients reprint ID cards, we ask that you use the new HealthSmart Preferred logo beginning July 1, 2011 for new business and renewals, and complete the transition to the new logo on ID Cards by July 1, 2012.

Where do we submit claims?

Please submit paper claims to the address on the member’s ID Card. If no address is visible or otherwise indicated on the ID Card, please submit paper claims to:
PO Box 53010, Lubbock, Texas 79453.

Will the network indicator listed on the EOP/EOB change?

Yes. During the next several months, the EOB language will transition to read “HealthSmart.” We will ask our payor partners to update their systems with new EOB remark codes. We realize that some payors may need more time than others to update their systems. Therefore, we have requested that HealthSmart providers be aware that they will continue to see older EOB language on the EOP/EOBs during this transition period.

How will you keep clients apprised of the status of the network integration and system conversion?

You can access information and all of the latest updates regarding our conversion and integration at www.healthsmart.com/NetworkIntegration.aspx. In addition, you can go to our Payor and Employer sections of www.healthsmart.com.

Where is the HealthSmart Preferred Care provider search located?

At the top of every webpage on www.healthsmart.com, there is a Provider Lookup link. Select the Provider Lookup link at the top of each webpage or go direct to http://providerlookup.healthsmart.com.