How We Help // Network Solutions

Health Payers Organization (HPO)

Cost-containment for out-of-network claims

Many members develop long-lasting, trusted relationships with their doctors. Unfortunately, not every provider participates in every network. When it’s a key provider or service category that falls out of the directory, this can be a real challenge and frustration for the member. The HealthSmart Payers Organization (HPO) helps members when it’s necessary to go out-of-network.

HPO addresses every aspect of out-of-network claims processing. Whether it’s HealthSmart’s own directly contracted national network or one of our HPO Network Partners, participants can go out-of-network to receive care at a reasonable cost.

  • Quick claim repricing turnaround with an efficient EDI connection
  • Discounts on over 85% of out-of-network claims submitted with average discounts more than 30%
  • Claims repriced at a fair, contractually negotiated rates for fewer unpredictable reductions
  • Minimal access requirements including no ID card logo and no financial incentives or steerage requirements

In partnership with HRGi, HPO combines our directly contracted provider network, partner networks and out-of-network negotiations to provide access and savings.