HealthSmart Network Solutions
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.
- Company typePrivate
- Founded1983
- HeadquartersRichardson, United States
- Headcount501–1,000
- GTM typeB2B
- OfferingServices
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.
HealthSmart Network Solutions firmographics
Firmographics- 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
HealthSmart Network Solutions industry classification
Industry- 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
Where HealthSmart Network Solutions is headquartered
LocationHeadquarters
- HQ city
- Richardson
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
HealthSmart Network Solutions business model
Business model- GTM type
- B2B
- Offering type
- Services
- Cost components
- Personnel, Technology or R&D, Operations, Marketing or Sales, Infrastructure
Revenue model
- 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.
- Claims Repricing Services: Revenue generated through claims repricing services for out-of-network claims through HPO, providing discounts on over 85% of claims submitted.
- Customized Network Solutions: Additional savings and revenue from customized network solutions that enhance primary PPO networks, including ancillary care services.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Annual | HealthSmart Preferred PPO |
| Subscription | Annual | Ancillary Care Services (ACS) |
| Transaction based/ take rate | Pay-as-you-go | Health Payers Organization (HPO) |
Go-to-market motion2 records
Distribution channels5 records
Marketing channels6 records
HealthSmart Network Solutions product offering
Product offeringCore 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
Companies that use HealthSmart Network Solutions
Customer profileNamed customers2 records
Segments6 records
Ideal customer profiles4 records
HealthSmart Network Solutions technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration2 records
Feature5 records
HealthSmart Network Solutions partnerships and signals
Strategic signalPartnerships
Five partnerships are on record, tiered core and minor.
- Expion HealthcorePartnership 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 GroupscoreACS 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)coreHealthSmart 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 NetworkminorACS secondary preferred provider network is used by the nation's 2nd largest network today, providing predictability in revenue and improving DSO metrics for providers.
- UnitedHealthcareminorPrivacy 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
HealthSmart Network Solutions competitors and assessment
Company assessmentEmerging 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
HealthSmart Network Solutions social profiles
Digital presenceHealthSmart Network Solutions compliance and trust
Trust signalCompliance3 records
HealthSmart Network Solutions financial estimates
Financial estimateRevenue estimate
Valuation estimate
HealthSmart Network Solutions leadership team
Management profileNumber of profiles
Profiles1 record
HealthSmart Network Solutions funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
HealthSmart Network Solutions 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 Network Solutions
What does HealthSmart Network Solutions do?
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.
Is HealthSmart Network Solutions a public or private company?
HealthSmart Network Solutions is a private company. It is classified as corporate owned and is currently operating.
When was HealthSmart Network Solutions founded?
HealthSmart Network Solutions was founded in 1983. It employs 501 to 1,000 people.
Where is HealthSmart Network Solutions based?
HealthSmart Network Solutions is headquartered in Richardson, United States, in the North America region.
How does HealthSmart Network Solutions make money?
Three revenue lines are on record. Network Access Fees are the primary driver. The others are claims Repricing Services and customized Network Solutions.
Who are HealthSmart Network Solutions's main competitors?
Emerging players on record are Cotiviti and Sedgwick (workers' comp network). Broad incumbents are Aetna (CVS Health), Blue Cross Blue Shield Association (and member plans), Humana, Cigna / Evernorth and UnitedHealthcare (UnitedHealth Group). Direct peers are First Health (Cigna Group affiliate), MultiPlan and Zelis.
Does HealthSmart Network Solutions have an API?
No public API is recorded for HealthSmart Network Solutions.
What industry is HealthSmart Network Solutions in?
HealthSmart Network Solutions's product category is Healthcare Provider Network Management. Its primary akta.pro industry code is HLAEAAAL, Provider Network & Care Management for Commercial Members, with a secondary code of HLAEANAA, National PPO Networks. Its NAICS code is 524292 and its SIC code is 6324.