HealthSmart Holdings
HealthSmart Holdings is a privately-held healthcare benefits administrator operating the nationwide HealthSmart Preferred Care Network, delivering network access, claims processing, and provider credentialing services to health plans, TPAs, and self-insured employers via dedicated web portals.
- Company typePrivate
- Founded1996
- HeadquartersBoulevard, United States
- Headcount1,001–5,000
- GTM typeB2B
- OfferingServices
What HealthSmart Holdings does
HealthSmart Holdings is a privately-held healthcare benefits administration and network solutions provider headquartered in Richardson, Texas. The company operates the HealthSmart Preferred Care Network, a nationwide, directly contracted and credentialed provider network that serves as the foundation for its service offerings. HealthSmart targets three primary B2B customer segments: health plans and Third Party Administrators (TPAs), self-insured employers, and contracted healthcare providers, with plan members as a downstream user base.
The company's product portfolio consists of interconnected portal-based services. HealthSmart Network Solutions provides flexible network leasing and administration for plan administrators and sponsors. WebExchange serves as the employer and benefit administrator portal for eligibility, claims, and plan management. Online Claim Status (OCS) gives contracted providers real-time claims tracking with multi-factor authentication security. The myHealth portal and Provider Lookup directory serve plan members with claims access and provider search capabilities across multiple specialties and languages. The underlying technology stack includes HIPAA-compliant electronic transactions, security standards, and credentialing systems integrated across the platform.
HealthSmart generates revenue through managed services fees, including network access fees charged to health plans, TPAs, and self-insured employers, as well as administrative fees for claims processing and care management. Pricing is quote-based and not publicly disclosed, reflecting a consultative B2B sales model. The company maintains regulatory compliance with HIPAA, GDPR, and the EU-US Privacy Shield framework. HealthSmart reports a Net Promoter Score of 52 and operates as a private corporation with two legal entities: HealthSmart Holdings, Inc. and HealthSmart Benefits Management, LLC, both governed under Texas law.
HealthSmart Holdings firmographics
Firmographics- Name
- HealthSmart Holdings
- Legal name
- HealthSmart Holdings, Inc.
- Website
- https://healthsmart.com
- Company type
- Private
- Founded year
- 1996
- Operating status
- Operating
- Headcount range
- 1,001–5,000 employees
- Short description
- HealthSmart Holdings is a privately-held healthcare benefits administrator operating the nationwide HealthSmart Preferred Care Network, delivering network access, claims processing, and provider credentialing services to health plans, TPAs, and self-insured employers via dedicated web portals.
- Ownership category
- akta.pro rank
HealthSmart Holdings industry classification
Industry- Product category
- Healthcare Benefits Administration
- NAICS
- Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292)
- SIC
- Hospital & Medical Service Plans (6324)
- akta.pro primary industry
- Care Management & Population Health Program Administration (HLAEALAG)
- akta.pro secondary industry
- Large Group Health Insurance (Mid-Market & National Accounts) (FSAIAFAE)
Keywords
Where HealthSmart Holdings is headquartered
LocationHeadquarters
- HQ city
- Boulevard
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
HealthSmart Holdings business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain
Revenue model
- Network Solutions and Administration Services: HealthSmart generates revenue through providing healthcare network solutions to health plans, TPAs, and employers. Revenue comes from administrative fees, network access fees, and contracted rates with providers. The company operates as an intermediary between payers (health plans, self-insured employers) and providers, earning fees for claims administration, network access, and care management services.
Go-to-market motion1 record
Distribution channels4 records
Marketing channels4 records
HealthSmart Holdings product offering
Product offeringCore offering
HealthSmart Holdings operates a healthcare benefits administration and network solutions platform serving health plans, third-party administrators (TPAs), self-insured employers, and providers. Its core offering combines a directly contracted, credentialed nationwide provider network (HealthSmart Preferred Care Network) with claims administration, eligibility and benefits management, and dedicated web portals for employers, providers, and members. The company acts as an intermediary between payers and providers, monetizing through administrative fees, network access fees, and contracted provider rates.
Product overview
HealthSmart Holdings operates as a healthcare benefits administration and network solutions company offering a platform of interconnected modules. The core offering includes HealthSmart Network Solutions, which provides flexible network services for payers and plan sponsors. This is supported by provider-facing Online Claim Status (OCS) for contracted providers to check claims, and WebExchange for employer administration. Members access services through myHealth portal and the Provider Lookup directory. The HealthSmart Preferred Care Network serves as the underlying contracted provider network. These products work together to provide end-to-end claims administration, provider network access, and member services for health plans, TPAs, employers, and providers.
Differentiator
Problem solved
Functional benefit
Companies that use HealthSmart Holdings
Customer profileSegments4 records
Ideal customer profiles3 records
HealthSmart Holdings technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Feature5 records
HealthSmart Holdings partnerships and signals
Strategic signalScale indicators2 records
Recent moves4 records
Expansion highlights3 records
HealthSmart Holdings competitors and assessment
Company assessmentBroad incumbents
- UMR (UnitedHealthcare): UMR is UnitedHealth Group's third-party administration arm focused on self-funded employer health plans, offering claims administration, network access, and utilization management. It is a direct functional competitor to HealthSmart in the TPA and PPO network space, with materially larger scale.
- eviCore (Evernorth / Cigna): eviCore, part of Cigna's Evernorth health services segment, provides utilization management and care management solutions to health plans and employers. It overlaps with HealthSmart's care management and network-adjacent services, though with broader vertical integration.
- Cigna Healthcare: Cigna operates a major health insurance carrier and Evernorth services business that includes PBM, care management, and network solutions, competing with HealthSmart across TPA-adjacent services and integrated employer offerings.
- UnitedHealthcare (Optum): UnitedHealthcare, with Optum services, is the largest U.S. health insurer and integrated health services platform. It competes broadly with HealthSmart through bundled network, administration, and care management offerings to self-funded employers and TPAs.
- Aetna (CVS Health): Aetna, owned by CVS Health, offers employer-sponsored health plans, network services, and integrated care management. It is a broad incumbent competitor to HealthSmart in the self-funded employer and TPA-administered segments.
Direct peers
- MultiPlan: MultiPlan operates one of the largest independent PPO networks in the U.S. and provides cost-management and network services to payers, TPAs, and self-funded employers. It is a close competitor to HealthSmart's HealthSmart Preferred Care Network on network rental and repricing services.
- Zelis Healthcare: Zelis provides healthcare cost management, network solutions, claims integrity, and payment accuracy services to payers, TPAs, and employers. It competes with HealthSmart across network access, claims administration, and provider network management.
- First Health Network: First Health Network is a national PPO network serving payers, TPAs, and self-funded employers — directly competitive with HealthSmart's preferred care network on network rental and provider access services.
- HealthLink: HealthLink provides preferred provider organization networks and administrative services to health plans, TPAs, and employers, overlapping with HealthSmart's network solutions and claims administration offerings.
- Private Healthcare Systems (PHCS): PHCS, part of MultiPlan, is one of the largest independent PPO networks in the U.S. and a direct competitor to HealthSmart's preferred provider network on nationwide network access and TPA support.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks6 records
Key highlights6 records
Customer concentration
HealthSmart Holdings social profiles
Digital presenceHealthSmart Holdings compliance and trust
Trust signalCompliance3 records
HealthSmart Holdings financial estimates
Financial estimateRevenue estimate
Valuation estimate
HealthSmart Holdings leadership team
Management profileNumber of profiles
Profiles4 records
HealthSmart Holdings funding detail
Funding detailFunding overview
Funding rounds1 record
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
HealthSmart Holdings M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about HealthSmart Holdings
What does HealthSmart Holdings do?
HealthSmart Holdings operates a healthcare benefits administration and network solutions platform serving health plans, third-party administrators (TPAs), self-insured employers, and providers. Its core offering combines a directly contracted, credentialed nationwide provider network (HealthSmart Preferred Care Network) with claims administration, eligibility and benefits management, and dedicated web portals for employers, providers, and members. The company acts as an intermediary between payers and providers, monetizing through administrative fees, network access fees, and contracted provider rates.
Is HealthSmart Holdings a public or private company?
HealthSmart Holdings is a private company. It is classified as unknown and is currently operating.
When was HealthSmart Holdings founded?
HealthSmart Holdings was founded in 1996. It employs 1,001 to 5,000 people.
Where is HealthSmart Holdings based?
HealthSmart Holdings is headquartered in Boulevard, United States, in the North America region.
How does HealthSmart Holdings make money?
One revenue line is on record: network Solutions and Administration Services.
Who are HealthSmart Holdings's main competitors?
Broad incumbents on record are UMR (UnitedHealthcare), eviCore (Evernorth / Cigna), Cigna Healthcare, UnitedHealthcare (Optum) and Aetna (CVS Health). Direct peers are MultiPlan, Zelis Healthcare, First Health Network, HealthLink and Private Healthcare Systems (PHCS).
Does HealthSmart Holdings have an API?
No public API is recorded for HealthSmart Holdings.
What industry is HealthSmart Holdings in?
HealthSmart Holdings's product category is Healthcare Benefits Administration. Its primary akta.pro industry code is HLAEALAG, Care Management & Population Health Program Administration, with a secondary code of FSAIAFAE, Large Group Health Insurance (Mid-Market & National Accounts). Its NAICS code is 524292 and its SIC code is 6324.