FREQUENTLY ASKED QUESTIONS

FAQs about HealthSmart Preferred Network Integration

Who is HealthSmart?

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

  • HealthSmart Benefits Solutions, a comprehensive healthcare benefit administrator
  • HealthSmart Care Management Solutions, a full-service care management company
  • HealthSmart Rx, a full-service prescription benefit manager
  • HealthSmart Primary Care Clinics, on-site employer-sponsored healthcare clinics
  • HealthSmart Information Systems, a healthcare IT provider with over 200 million EDI transactions
  • HealthSmart Provider Networks, PPO networks which encompasses several directly-contracted provider networks such as HealthSmart ACCEL, HealthSmart Preferred Care, HealthSmart Payors Organization, Interplan Health Group, Emerald Health Network and Preferred Plan, Inc.
What is HealthSmart Preferred Care?

The HealthSmart Preferred Care network is one of our wholly-owned nationwide preferred provider organizations. HealthSmart formed HealthSmart Preferred Care in 1993. Beginning as a network with a significant presence in the Southwest, it is now available throughout the United States.

Why are you integrating your networks – Interplan Health Group, Emerald Health Network, Physicians Direct 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. Prior to integration, each network has operated independently, which led to operational inefficiencies. The effort and expense of maintaining these independent systems, processes and personnel kept us from offering our customers the best price possible for our services. With this network integration, HealthSmart is utilizing a new state-of-the-art PPO management 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 will we be using HealthSmart Preferred as the name of this integrated network?

We could have chosen any name for the combined network, but HealthSmart Preferred is a network brand that our company built from the ground up and grew over the last 18 years. In addition, both our company and the network share the HealthSmart name.

Will providers need to sign a new agreement with HealthSmart Preferred?

No. Your current agreement as a provider will remain in full force.

Will the fee schedule or reimbursement change?

No. There are no changes to your current reimbursement schedule.

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

Members using HealthSmart networks are issued Identification (ID) Cards. Please accept members with ID Cards displaying legacy logos as well as the HealthSmart Preferred logo. For more details on logos, CLICK HERE. Note that members are issued ID Cards by payor companies and each card will differ depending on the payor. In addition, it is the decision of the payor when to reprint member ID Cards with the updated logo.

Which logos will be on the member ID Cards?

It depends on the payor that issues the ID Cards. Members may have ID Cards displaying the legacy network logos or members could be issued updated ID Cards. For more details on logos, CLICK HERE.

When should a provider no longer accept a legacy logo?

Over the next 13 months, payors will update member ID Cards to reflect the new HealthSmart Preferred logo. During the transition, from now until July 2012, please accept members with ID Cards displaying the legacy logos as well as the new HealthSmart Preferred logo.

Where do providers submit paper claims or electronic 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.

You can also submit electronic claims. HealthSmart offers a full service EDI Clearinghouse, which is open to all healthcare providers. For more information, email support.his@healthsmart.com or call 888.744.6638. CLICK HERE for details on submitting claims.

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

Each payor is being asked to update their systems with the new EOB remark codes. However, the timing of the system change is dependent on the date each payor updates their systems. Some payors may update their EOP/EOBs quickly. Others may need more time before their systems are ready with the new network name. Over the next several months, providers will continue to see EHN networks listed on the EOP/EOBs during the transition period.

What is the website that I should access for information?

You can access information and all of the latest updates regarding our integration at www.healthsmart.com/NetworkIntegration.aspx. In addition to integration information, you can go to our Provider section of www.healthsmart.com to access the following information, forms and tools:

Where is the HealthSmart Preferred provider directory located?

Please access www.healthsmart.com and select the Provider Lookup link at the top of each webpage or go direct to http://providerlookup.healthsmart.com.

When will clients be notified of the network integration?

HealthSmart contacted all of our clients in May 2011.

Where should I submit provider demographic changes, updates and terminations?

There are no changes to your current submission request process. Please continue to submit your requests to the same email address you are currently using.