HealthSmart Holdings

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.

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

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

• Healthcare network solutions
• Benefits administration
• Claims processing
• Provider network management
• Self-funded health plans

Headquarters

HQ city

Boulevard

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Supply Chain

Revenue model

1. 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

Core 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

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature5 records

Scale indicators2 records

Recent moves4 records

Expansion highlights3 records

Broad 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

• LinkedInlinkedin.com/company/healthsmart
• Xx.com/HealthSmartCare
• Facebookfacebook.com/HealthSmartWellness

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds1 record

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about HealthSmart Holdings