REPRICING SERVICES

Nowhere does HealthSmart's negotiating skill and knowledge of the healthcare industry come into play as much as it does in repricing. Equipped with a highly qualified and experienced repricing team, combined with our technologically advanced repricing system, HealthSmart keeps maximum savings in mind when customizing and negotiating provider contracts.

Four Methods, One Common Goal

HealthSmart offers repricing services to our clients in one of four ways: Electronic Data Interchange (EDI), Web-based Repricing transmissions, Scanning of paper claims, and traditional Paper Claims repricing. When submitting claims, our clients are free to select the method or combination of methods that works best for them. Regardless of how a claim is submitted, the goal is the same—maximum savings in the minimum amount of time.

1. EDI

HealthSmart welcomed EDI capability in 2002. Our information technology group works closely with customers to initiate and maintain EDI connectivity.

2. Web-based Repricing

In Web-based repricing, claims are submitted over the Internet through a secure connection. Once the information is received, it is repriced on our secure servers for maximum security and efficiency.

3. Scanning

For clients able to receive EDI, we can scan paper claims and return repriced claims in an ANSI 837/4010 format. Eligibility data is required to support this service.

4. Paper Claims

HealthSmart routinely applies the same strict turnaround and quality standards to paper claims as we do to automated methods.


Once claims are received, our automated repricing system calculates the discount and the integrity of the claim ensuring a quick turnaround time. Even more complex claims can be handled swiftly, thanks to the experience and skill of an accomplished repricing team dedicated to providing excellent customer service with each and every claim.

HIPAA Requirements

As with all HealthSmart processes, our repricing system is fully compliant with HIPAA and industry data collection reporting standards. In fact, many of the HIPAA requirements impact our computer systems and the way we process, transmit and store data. The following changes show how we have implemented systems to accommodate these very specific requirements:

  • Implementation of the ANSI X12 837 transaction for clients who submit claims through Interplan Health Group.
  • Standardization of claims data code sets to comply with the HIPAA Implementation Guide (CPT, ICD9-CM, HCPCS Level II, POS, etc.)