Payers

For some health plans and third party administrators (TPAs), it makes sense to work with partners for services such as cost containment, provider network management, utilization review or pre-certification, just to name a few. To help payers provide more robust services, HealthSmart offers a comprehensive set of solutions to complement payer capabilities.

• Nationwide provider networks through HealthSmart Preferred (PPO), our Physician and Ancillary Network (P&A) and HealthSmart Payer Organization (HPO)
• Claims repricing with Electronic Data Interchange (EDI) Clearinghouse services to streamline the claims workflow
• Care management solutions for effective disease management and utilization review
• Extremely competitive pharmacy benefit management (PBM) with high cost drug management (HCDM) solutions

With HealthSmart's comprehensive solutions and outstanding customer support, we help manage the health cost spend while improving outcomes for members. In fact, we have partnerships with more than 200 payers across the country, helping their clients improve and expand  services, reduce costs. and increase value to their members.