How We Help // Benefit Solutions

SmartDecision Reference Based Pricing

Smart tools with a high-touch concierge service

HealthSmart_SmartDecision.pngAs self-funded employers look for ways to lower the cost of healthcare for their employees while maintaining quality, HealthSmart offers its SmartDecision™ Reference Based Pricing Solution.

SmartDecision leverages the best solutions to enable employers to lower healthcare costs with quality providers, while providing white glove service through our SmartDecision Concierge Desk.
 

We Made Healthcare Smart

SmartDecision is a multi-faceted solution that includes a referenced based pricing solution, outpatient bundled payments, physician and ancillary PPO networks, and a quality and transparency tool.

SmartDecision Reference Based Pricing delivers overall savings of more than 60 to 70 percent off hospital and facility billed charges. Using our RBP tool powered by Zelis® Healthcare, this program directs members to high quality providers who accept RBP payments, and negotiates with providers who are not in agreement with the proposed Medicare Cost Plus reimbursement.

Our proprietary MyDecision™ solution bundles services for elective, non-urgent outpatient procedures with our network of high quality and actively redirects members to participating providers. The result is four to seven percent medical plan spend savings with ZERO out-of-pocket for members.

Limited to specific states.

Physician & Ancillary Networks effectively manage and control physician and ancillary costs. For these lower cost claims, using PPO fee schedules is more efficient and reduces the potential for appeals. Our directory tool manages access to multiple networks and participating providers. 

Healthcare Bluebook™ provides cost transparency on pricing and quality information on providers. This helps members understand the fair prices for procedures in specific areas, and compare providers based on cost and quality.
 

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The SmartDecision Concierge Makes Healthcare Simple

SmartDecision offers members a high-touch, single point of contact for all service and benefit questions. The SmartDecision Concierge Desk direct members to the most cost-effective, high quality providers. Likewise, our concierge specialists work directly with providers to confirm reimbursement amounts and answer associated questions.

  • Locate a physician or facility
  • Educate the member and provider on HealthSmart’s Reference Based Pricing program
  • Provide education and options on HealthSmart’s MyDecision Program
  • Help direct care to the most cost-effective, high quality providers
  • Answer questions about benefits and coverage
  • Help with claims and appeals inquiries
Contact us today to learn more how about SmartDecision can lower your medical plan costs with high quality providers. 

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