HealthSmart Network Solutions

What HealthSmart Network Solutions does

HealthSmart Network Solutions (legal entity: HealthSmart Benefits Management, LLC) is a Richardson, Texas-based provider of customizable healthcare network management services for self-funded health plans, operating as a subsidiary within UnitedHealth Group. Founded in 1983 with 501-1,000 employees, the company targets self-insured employers, third-party administrators, benefits consultants, and health plans through enterprise field sales and channel partnerships with over 600 TPA payors and employer groups. Its product portfolio spans six core network offerings: HealthSmart Preferred PPO, National Ancillary Solution (ACS) covering 32+ service categories with 42,000+ providers, Health Payers Organization (HPO) for out-of-network cost containment in partnership with Expion Health, Workers' Compensation Network (120,000+ providers), Auto Medical Network (100,000+ providers), and HealthSmart Dental California (5,000+ dentists).

Underlying these networks is a healthcare management platform comprising a claims processing system rated Best in Klas for three consecutive years with 96%+ auto-adjudication, a HIPAA-compliant EDI clearinghouse supporting commercial claims and eligibility verifications, the SmartInquiry web-based client reporting portal, a public provider lookup directory, and CAQH-integrated credentialing tools. The technology stack supports seamless integration with existing payer systems via EDI installation.

HealthSmart's business model combines recurring network access fees (annual subscription billing on HealthSmart Preferred and ACS, with ACS structured with no PEPM or percentage-of-savings fees) with transaction-based repricing revenue (HPO take rate on out-of-network claims, achieving 30%+ discounts on over 85% of claims). Distribution occurs through direct enterprise sales, channel partnerships with TPAs and aggregators, and a "Join Our Network" provider recruitment program. The company reports an NPS of 52 and discloses measurable cost savings across ancillary (8-12% above primary PPO), dental (25%+), and out-of-network (30%+) categories, though specific revenue and headcount growth figures are not publicly disclosed.

Name

HealthSmart Network Solutions

Legal name

HealthSmart Benefits Management, LLC

Website

https://healthsmartnetworksolutions.com

Company type

Private

Founded year

1983

Operating status

Operating

Headcount range

501–1,000 employees

Short description

HealthSmart Network Solutions, a UnitedHealth Group subsidiary, provides customizable provider network management and claims processing for self-funded employers, TPAs, benefits consultants, and health plans, operating six nationwide networks spanning PPO, ancillary, out-of-network, workers' compensation, auto medical, and dental.

Ownership category

akta.pro rank

Product category

Healthcare Provider Network Management

NAICS

Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds (524292), Health and Welfare Funds (525120)

SIC

Hospital & Medical Service Plans (6324), Services-Misc Health & Allied Services, Nec (8090)

akta.pro primary industry

Provider Network & Care Management for Commercial Members (HLAEAAAL)

akta.pro secondary industries

National PPO Networks (HLAEANAA), Managed Care / Network-Based Group Health Plans (Carrier Network Products) (FSAIAFAO)

Keywords

• Healthcare provider networks
• Self-funded health plans
• PPO network solutions
• Claims processing services
• Out-of-network cost containment

Headquarters

HQ city

Richardson

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Network Access Fees: HealthSmart generates revenue through network access fees charged to clients for access to their provider networks. The ACS network does not require a fee, while other networks charge competitive network access fees.
2. Claims Repricing Services: Revenue generated through claims repricing services for out-of-network claims through HPO, providing discounts on over 85% of claims submitted.
3. Customized Network Solutions: Additional savings and revenue from customized network solutions that enhance primary PPO networks, including ancillary care services.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels6 records

Core offering

HealthSmart Network Solutions provides customizable, scalable provider network solutions for self-funded health plans, including PPO networks, ancillary care networks, workers' compensation networks, auto medical networks, dental networks, and out-of-network cost containment services. The company sells network access, claims processing through a Best-in-Klas platform with 96%+ auto-adjudication, and EDI clearinghouse services to self-insured employers, TPAs, health plans, and benefits consultants. Its directly contracted and credentialed providers deliver nationwide coverage across multiple specialized network types.

Product overview

HealthSmart Network Solutions offers a platform of customizable, scalable network solutions for self-funded health plans. The core product portfolio includes HealthSmart Preferred (PPO solution), HealthSmart Physician & Ancillary Network (complements RBP/PPO plans), and National Ancillary Solution/ACS (standalone ancillary network). These work alongside specialized networks: Health Payers Organization (HPO) for out-of-network cost containment, Workers' Compensation Network (120,000+ providers), Auto Medical Network (100,000+ trauma providers), and HealthSmart Dental California (5,000+ dentists in CA). The networks provide nationwide coverage through directly contracted and credentialed providers, enabling employers to customize plans that deliver access and quality at competitive pricing.

Differentiator

Problem solved

Functional benefit

Products and services

• HealthSmart Preferred PPO Flexible PPO solution offering nationwide reach with high-quality, credentialed providers. Can serve as a primary or wrap network option, and includes narrow network options for increased savings and positive outcomes. Targeted at self-funded employers and plan administrators.
• HealthSmart Physician & Ancillary Network Flexible physician and ancillary network designed to complement Reference-Based Pricing (RBP) plans and full-coverage PPOs. Offers customized solutions with discounts at or below carrier networks without balance billing risk.
• National Ancillary Solution (ACS) Standalone ancillary network that expands and enhances employers' primary networks. Covers 32+ service categories including dialysis, diagnostic imaging, physical therapy, and long-term acute care, with 8-12% average savings above primary PPO. No network access fees (PEPM or percentage of savings).
• Health Payers Organization (HPO) Comprehensive out-of-network cost containment solution providing 30%+ discounts on over 85% of out-of-network claims. Addresses every aspect of out-of-network claims processing in partnership with Expion Health.
• Workers' Compensation Network National network of 120,000+ participating providers and facilities specializing in workers' compensation care. Offers smooth claims processing, real-time repricing, and dedicated staff to help employees return to work.
• Auto Medical Network National network of 100,000+ providers and facilities specializing in trauma-related injuries and special medical needs. Features direct contracts for personal, efficient working relationships at competitive rates.
• HealthSmart Dental California PPO network of over 5,000 participating dentists at more than 10,000 locations in California. Geared for fully or self-insured members with average savings of 25% or more.

Quantifiable outcome

• 8-12% savings above primary PPO for ancillary care
• +5 more outcomes

Named customers2 records

Segments6 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature5 records

Partnerships

Five partnerships are on record, tiered core and minor.

• Expion HealthcoreStrategic or Co-development PartnerPartnership with Expion Health combines HealthSmart's directly contracted provider network, partner networks, and out-of-network negotiations to provide access and savings for HPO (Health Payers Organization) out-of-network cost containment solutions.
• Over 600 TPA Payors and Employer GroupscoreChannel Partner/ Reseller/ DistributorACS primary group health network includes access to national & regional PPO networks as well as over 600 TPA payors and employer groups across the nation.
• CAQH (Council for Affordable Quality Healthcare)coreTechnology or IntegrationHealthSmart participates in the Universal Credentialing DataSource, a web-based solution allowing providers to store and manage credentialing information online and share with insurance carriers electronically.
• The Nation's 2nd Largest NetworkminorChannel Partner/ Reseller/ DistributorACS secondary preferred provider network is used by the nation's 2nd largest network today, providing predictability in revenue and improving DSO metrics for providers.
• UnitedHealthcareminorOthersPrivacy matters for UnitedHealthcare are handled through Mitchell Granberg, Deputy General Counsel. HealthSmart privacy policy references UnitedHealthcare context.

Scale indicators13 records

Recent moves7 records

Expansion highlights4 records

Emerging players

• Cotiviti: Cotiviti provides payment accuracy, claims editing, and network optimization services to payers and providers; partial overlap with HealthSmart's claims processing and repricing capabilities.
• Sedgwick (workers' comp network): Sedgwick operates workers' compensation managed care services and provider networks, directly competing with HealthSmart's Workers' Compensation Network for employer and carrier accounts.

Broad incumbents

• Aetna (CVS Health): Aetna operates a large national PPO/HMO network and offers self-funded plan administration, ancillary networks, and worksite solutions — directly competing with HealthSmart's wrap and ancillary offerings at large national employers.
• Blue Cross Blue Shield Association (and member plans): BCBS member plans collectively form the largest U.S. PPO network and compete with HealthSmart's wrap and ancillary products for self-funded employer accounts nationwide.
• Humana: Humana offers national provider networks, group health plans, and specialty/ancillary solutions for employer-sponsored and self-funded plans, overlapping with HealthSmart's PPO and ACS products.
• Cigna / Evernorth: Cigna, through Evernorth, provides national PPO networks, specialty and ancillary solutions, and stop-loss products for self-funded employers, competing with HealthSmart across multiple product lines.
• UnitedHealthcare (UnitedHealth Group): UnitedHealthcare is HealthSmart's parent and one of the largest national PPO carriers; it offers overlapping provider network, claims administration, and ancillary products through Optum, creating both parental alignment and competitive overlap.

Direct peers

• First Health (Cigna Group affiliate): First Health is a national PPO rental network serving self-funded plans, TPAs, and labor unions — directly comparable to HealthSmart Preferred PPO in scale and go-to-market model.
• MultiPlan: MultiPlan is a leading national provider of healthcare cost management solutions, offering PPO network rental, OON repricing, and claims cost containment — directly overlapping with HealthSmart's PPO, HPO, and ACS offerings for self-funded plans.
• Zelis: Zelis provides healthcare cost management including network rental, OON claims repricing, and payment integrity — a direct competitor to HealthSmart's HPO and PPO wrap products serving TPAs and self-funded employers.

Market position

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/healthsmart

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

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 Network Solutions