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 and reporting on fully-integrated administrative platforms
	HealthSmart Accel PPO Network	Strategic and unique partnerships with market leading regional providers as well as an experienced team of out-of-network claims negotiators
	Care Management and Wellness Programs	Effective care management through predictive modeling, case management, disease management and wellness initiatives
	Pharmacy Benefit Management	Reducing pharmacy expenses through transparency and a 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 Six Years
Dedicated Account Management & Claims Examiners
Automated Online Clinical Editing
Complete Suite of Online Reporting & Analytics

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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
Experienced Out-of-Network Claims Negotiation Team
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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