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Provider Frequently Asked Questions (FAQs)

 

Customer Service

 

Q. How can I reach the HealthSmart Customer Service Department?

A. You can contact HealthSmart by calling the toll-free number on your ID card, or the toll-free number 1-800-624-8605 during our regular business hours Monday through Friday from 7:00 a.m. to 7:00 p.m. (EST).

 

Q. Where can I check on claim status or Participant eligibility?

A. You can check on claim status or Participant eligibility by calling HealthSmart's Customer Service Department at 1-800-624-8605, or you can access information on our website. In order to check claim status on our website, you must first register as a provider and obtain security access.

 

Please note: A summary of benefits and/or eligibility is not a guarantee of payment. Benefit determinations will be based on eligibility and plan limits at the time services are rendered. Benefits information only applies to procedures and diagnoses that are covered by the plan. We encourage you to review the Summary Plan Description (SPD) to determine if the charges in question are covered expenses. Pre-authorization requests for a specific diagnosis or procedure must be submitted in writing.

 

Q How do I obtain provider access to claims information on your website?

A. Our website requires you to first register to the site. However, security requirements have required us to eliminate the self-registration process for this site. To register, please call our Help Desk at 1-800-638-0968, or click here to send an email to request access. In your email, please specify that you are requesting provider website access and list your name, telephone number, email address, provider name and address, and tax identification number.

 

Please note: We are only available for site registration Monday through Friday from 8:00 a.m. to 4:30 p.m. (EST).

Q. Where can I get a summary of benefits?

A. Most employers distribute a benefits booklet, also known as a Summary Plan Description (SPD), directly to their employees. SPDs are not available for distribution to the provider community. Benefits available vary by employer. For assistance, you may call HealthSmart's Customer Service Department at 1-800-624-8605.

 

Q. Does HealthSmart have any special requirements for use of the National Provider Identifier (NPI)?

A. Please refer to our Resources section on our website for more information on NPI.

 


Preferred Provider Networks

 

Q. How can I join a HealthSmart preferred provider network?

A. HealthSmart does not have a national provider network. To learn more about a membership in our preferred provider network, please contact the network listed on the Participant ID card.

 


Claims and Explanations of Benefits (EOBs)

 

 

Q. Who can I contact if I have a question about a payment or wish to appeal an adverse benefit determination?

A. Please contact HealthSmart's Customer Service Department at 1-800-624-8605 for assistance.

 

Q. Does HealthSmart require any special claim forms?

A. No, the standard HCFA and UB92 forms are accepted. The cardholder’s full social security number or other alternate identification number (as provided on the identification card) must be provided on all claim submissions. Do not use the letter X as part of your social security number.

 

Q. What is the claim mailing address?

A. You can find the mailing address for submitting claims on our website under “Contact Us”. Please check your Participant ID card to make sure claims should be mailed directly to HealthSmart and not to another address.

 

Q. Can providers submit claims electronically to HealthSmart?

A. Currently, you can submit HCFA 1500 and UB92 claims electronically to HealthSmart from a variety of clearinghouses, including Emdeon (formerly WebMD/Envoy/NEIC), SSI, and Proxymed. Please list HealthSmart's Payor ID (87815) when submitting electronic claims. Providers should contact their software vendor to determine if they are compatible to submit claims electronically to HealthSmart The cardholder’s full social security number or other alternate identification number (as provided on the identification card) must be provided on all claim submissions. Do not use the letter X as part of the social security number.

 


Pre-Certification and Pre-Authorization

 

Q. What is pre-certification and when is it required?

A. Pre-certification is obtaining authorization from the health plan for a hospital admission, or other services as defined in the Summary Plan Description (SPD). Failure to obtain pre-certification may result in a financial penalty or denial of benefits, as outlined by the employer's benefit plan. Pre-certification requirements vary by employer. Please refer to your SPD for specific plan requirements, or contact HealthSmart's Customer Service Department at 1-800-624-8605.

 

Please note: Summary of benefits and/or eligibility is not a guarantee of payment. Benefit determinations will be based on eligibility and plan limits at the time services are rendered. Benefits information only applies to procedures and diagnoses that are covered by the plan. We encourage you to review the SPD to determine if the charges in question are covered expenses. Pre-authorization requests for a specific diagnosis or procedure must be submitted in writing.

 

Q. What does pre-authorization mean and when is it required?

A. A pre-authorization is a request made prior to a procedure to verify benefits and medical appropriateness of the procedure. This allows the patient to make an informed decision of potential coverage for the procedure in advance. If you are unsure about whether a service or procedure should be pre-authorized, please contact HealthSmart’s Customer Service at 1-800-624-8605 for more information.

 

Please note: A summary of benefits and/or eligibility is not a guarantee of payment. Benefit determinations will be based on eligibility and plan limits at the time services are rendered. Benefits information only applies to procedures and diagnoses that are covered by the plan. We encourage you to review the Summary Plan Description (SPD) to determine if the charges in question are covered expenses. Pre-authorization requests for a specific diagnosis or procedure must be submitted in writing.

 


1099 Reporting and W9 Requirements

 

Q. Does HealthSmart send 1099 information to the Internal Revenue Service (IRS) for payments made to specific providers?

A. Yes, HealthSmart electronically submits annual payment information to the IRS.

 

Q. How often do I need to submit a W9 form to HealthSmart?

A. You only need to submit a W9 form when requested. Failure to provide a W9 form, or certified W9 form when requested may result in an IRS required withhold of payment.