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efficient and effective administration

No cost control strategy can be successful without first addressing the efficient and effective administration of existing benefit plans. Examples include:

• Accurate eligibility and claims adjudication
• Efficient administration
• Use of audit programs, out-of-network fee negotiations
• Aggressive pursuit of subrogation opportunities
• Identification of cost-effective networks, providers and PBM’s
• Use of reporting and data mining to identify costly trends and cost centers

HealthSmart Benefit Solutions aggressively uses all of these techniques, and more, to make certain that our clients pay no more than is required by their plan design. Generally, these services, including the use of audit programs and subrogation recovery, are part of our standard administration fee.

Using the industry-leading QicLink™ system from Trizetto®, HealthSmart Benefit Solutions seamlessly manages key health claims transaction processes, including membership, provider files, plan definition and re-insurance.

While technology and systems are important, so is experience. The Benefits Analysts at HealthSmart Benefit Solutions are among the most experienced and professional in the industry. Many had extensive backgrounds with various national carriers before joining our firm.

Whereas the average length of industry experience for most claims examiners is five years, HealthSmart Benefit Solutions benefit analysts average more than 10 years of industry experience.

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Our five-year average claim turnaround time is 7 days from the time we receive a claim.


The Benefits Analysts at HealthSmart Benefit Solutions are among the most experienced and professional in the industry.

 

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