PAYOR SERVICES

Our partnerships, national presence and pursuit of excellence allow us to complement any employer, payor, or third party administrator in the areas of cost containment, provider network management, utilization review, pre-certification and other management services. HealthSmart understands that as payors, you need easy access to information relevant to your business.

Clean Claims

For payors of self-administered health plans, we offer complete Electronic Data Interchange (EDI) Clearinghouse services. Our services facilitate "clean claims", resulting in reduced administrative costs for you and improved customer service with your providers. We offer both batch and real-time transactions, including all payor-to-provider transactions addressed in the final HIPAA regulations:

  • Claim and encounter submission
  • Claim status inquiry and response
  • Eligibility inquiry and response
  • Review/Inquiry/Response request
  • Electronic Remittance Advice (ERA) delivery

Electronic Claims Mailbox

When you become a HealthSmart Payor, you have access to an Electronic Claims Mailbox that provides the following:

  • EDI data files so that you can retrieve claims that have been processed (scanned, OCR, and repriced)
  • Original claim images and attachments (such as .tif files generated from scanned paper claims)
  • Reprinted (repriced) claims

Ongoing and Comprehensive Support

HealthSmart understands the importance of continuing the relationship with our customers after the implementation process has been completed. By partnering with our clients, our experienced EDI staff will assist you in contacting high-volume paper submitters and offering EDI solutions that will help you:

  • Increase electronic claim volumes
  • Reduce administrative costs
  • Reduce support issues regarding eligibility, claim status, ERAs, and referral authorization requests
  • Convert paper claims to an electronic format allowing for online access to claim images