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Provider Services

Answers to frequently asked questions by providers

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.

  • Commercial claims (Aetna, CIGNA, Humana, etc…) to providers
  • Free government claims to participating carriers
  • Eligibility verifications
  • Claim status inquiry
  • Electronic remittance advice (ERA) for auto payment posting
  • Referral and authorization requests
  • e-Paper (Print-Mail Services)
  • Patient statements

EDI Benefits

Let HealthSmart be your single source of EDI transactions. By utilizing the above features providers experience the following benefits:

  • Faster reimbursement
  • Reduce rejected claims (Clean Claims)
  • Decrease time-intensive manual tasks
  • Increase productivity and efficiency
  • Improve cash flow

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.

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