HealthSmart Insight

Integrated Health Plan for 50+ Employee Groups

HealthSmart Insight is our fully-integrated healthcare solution for the self-funded employer. HealthSmart Insight includes several of our wholly-owned products and services bundled together for ultimate employer savings:

	Benefit and Claims Administration	Comprehensive health plan administration
	HealthSmart Accel PPO Network	Strategic and unique partnerships with market leading regional providers
	Care Management and Wellness Programs	Aggressive care management through predictive modeling, case management, disease management and wellness initiatives.
	Pharmacy Benefit Management	Reducing pharmacy expenses through transparency and focus on generic utilization
	Risk Management Services	Providing risk management solutions designed to minimize the employer's financial exposure

Benefit & Claims Administration: Comprehensive Health Plan Benefit Services

Fully-Integrated Administrative Operating Platform for Claims, Voice and Data
Examiners, Administrators & Customer Service Representatives With an Average Tenure of 6 Years
Dedicated Account Management & Claims Examiners
Automated Online Clinical Editing
Complete Suite of Online Reporting & Analytics
Out-of-Network Claims Negotiation Team

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HealthSmart Accel PPO Network: Significant Cost Savings From Quality Healthcare Providers

Excellent Hospital & Physician Access
Market-Leading Discounts
Payment & Audit Guidelines Consistent With Carrier Guidelines, Including Out-of-Network
Electronic Claims Processing – Submission, Remittance Advice & Fund Transfer
Online Claim Status & Eligibility
Dedicated Provider Relations Team

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Care Management & Wellness Programs: Dedicated To Improving Members’ Health and Minimizing Plan Expenses

Care Management
Utilization Review / Precertification
Large Case Management
Managed Maternity Program
Disease Management
Predictive Modeling
Transplant Management
Health Advice Line (Demand Management)
Health Assessments / Wellness Coaching

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Pharmacy Benefit Management: Reducing Pharmacy Expenses Through Transparency and Focusing On Generic Utilization

Nationwide Network With Over 60,000 Participating Pharmacies
Brand Name, Generic & Mail Order Pricing
Generic and Brand Formulary Options
On-line Access To: Benefit & Eligibility Information, Accumulators & Out-of-Pocket Tracking and Claims History

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Reinsurance & Risk Management: Reduces Financial Exposure and Premium Expenses

Products Backed by Highly Rated Carriers
Preferred Partners Who Have Evaluated HealthSmart’s Managed Care Tools
Traditional Specific & Aggregate In All 50 States
Our Partners Deliver the Most Competitively Priced Solutions In the Market
Creative Solutions to Help Manage Our Client’s Risk

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