Core services
Comprehensive solutions designed to improve outcomes and reduce costs
Provider Resources
Online provider access to member health benefits and claims information
Get real-time access to member eligibility, claims status, and essential patient information all in one integrated platform.
Comprehensive provider services
With our growing provider base, members have better access to the best care available. We are committed to providing the best care for our members and the best provider services, including expedited claims turnaround times. HealthSmart providers have access to a variety of services, including real-time, online access to useful patient information.
Here, you can:
To request a client list please Contact Us
For questions about benefits, eligibility or claims, please contact the number on the member’s ID card.
Fast, accurate claims processing
Our partnerships with providers on our PPO networks ensure expedited claims turnaround time and stable patient base for your business.
EDI services
Access our EDI Clearinghouse for commercial claims, eligibility verification, referral and authorization requests, and more.
Online claim status
Free online claim status service for providers contracted with HealthSmart networks. Real-time status inquiries available 24/7.
Credentialing & recredentialing
Utilize Universal Credentialing DataSource (CAQH) for streamlined credentialing information management and sharing.
Fast, Accurate Claims Processing that You can Count On
Our partnerships with the providers on our PPO networks is a testament to our pursuit of excellence. With each partnership, a HealthSmart provider can expect an increase in patient flow, a stable patient base and an expedited claims turnaround time. When you become a HealthSmart provider, we provide an array of seamless services to help you with your business.
EDI Services
HealthSmart offers a Full Service Healthcare EDI Clearinghouse, which is open to all providers in the healthcare community. Our goal at HealthSmart is to give our network providers the highest level of customer service possible. Engineered with the latest technology, HealthSmart is committed to meeting all HIPAA requirements and leading the way in healthcare EDI services.
EDI Services Include:
EDI benefits
Online Claim Status
A popular feature of our online services is our free Online Claim Status service available to providers who are contracted with several of our HealthSmart networks. Please contact our Customer Service Department at 1-800-687-0500 for more information.
Online Credentialing and Recredentialing
We are pleased to participate in the Universal Credentialing DataSource, a project of the Council for Affordable Quality Healthcare (CAQH). This web-based solution allows you to store and manage your credentialing information online and share it with insurance carriers electronically.
Fraud, Waste & Abuse
HealthSmart Network Solutions believes that when you report a situation that you believe is fraudulent, wasteful or abusive (FWA), you are doing your part to protect patients, save money for the health care system and prevent personal loss for others. Taking action and making a report is an important first step. After your report is made, we work to detect, correct and prevent FWA in the health care system.