HEALTHSMART INSIGHT

Integrated Health Plan for 50+ Employee Groups

HealthSmart Insight is our fully-integrated healthcare solution for the self-funded employer. HealthSmart Insight includes several of our wholly-owned products and services bundled together for ultimate employer savings:

  • Benefit and Claims Administration

    Comprehensive health plan administration and reporting on fully-integrated administrative platforms

  • Network Solutions

    Strategic and unique partnerships with market leading national and regional providers as well as an experienced team of out-of-network claims negotiators

  • Care Management and Wellness Programs

    Effective care management through predictive modeling, case management, disease management and wellness initiatives

  • Pharmacy Benefit Management

    Reducing pharmacy expenses through transparency and a focus on generic utilization

  • Risk Management Services

    Providing risk management solutions designed to minimize the employer's financial exposure

Benefit & Claims Administration: Comprehensive Health Plan Benefit Services

  • Fully-Integrated Administrative Operating Platform for Claims, Voice and Data
  • Examiners, Administrators & Customer Service Representatives With an Average Tenure of Six Years
  • Dedicated Account Management & Claims Examiners
  • Automated Online Clinical Editing
  • Complete Suite of Online Reporting & Analytics

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HealthSmart Accel PPO Network: Significant Cost Savings From Quality Healthcare Providers

  • Excellent Hospital & Physician Access
  • Market-Leading Discounts
  • Payment & Audit Guidelines Consistent With Carrier Guidelines
  • Experienced Out-of-Network Claims Negotiation Team
  • Electronic Claims Processing – Submission, Remittance Advice & Fund Transfer
  • Online Claim Status & Eligibility
  • Dedicated Provider Relations Team

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Care Management & Wellness Programs: Dedicated To Improving Members’ Health and Minimizing Plan Expenses

  • Care Management
  • Utilization Review / Precertification
  • Large Case Management
  • Managed Maternity Program
  • Disease Management
  • Predictive Modeling
  • Transplant Management
  • Health Advice Line (Demand Management)
  • Health Assessments / Wellness Coaching

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Pharmacy Benefit Management: Reducing Pharmacy Expenses Through Transparency and Focusing On Generic Utilization

  • Nationwide Network With Over 60,000 Participating Pharmacies
  • Brand Name, Generic & Mail Order Pricing
  • Generic and Brand Formulary Options
  • On-line Access To: Benefit & Eligibility Information, Accumulators & Out-of-Pocket Tracking and Claims History

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Reinsurance & Risk Management: Reduces Financial Exposure and Premium Expenses

  • Products Backed by Highly Rated Carriers
  • Preferred Partners Who Have Evaluated HealthSmart’s Managed Care Tools
  • Traditional Specific & Aggregate In All 50 States
  • Our Partners Deliver the Most Competitively Priced Solutions In the Market
  • Creative Solutions to Help Manage Our Client’s Risk

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