HealthSmart MSO claims department provides efficient and prompt claims processing services for our contracted IPA’s, Managed Hospitals and provides claims adjudication in contract agreements. Our experienced staff at HealthSmart MSO is familiar with Medicare (CMS), Medi-Cal, Healthy Families and Commercial regulatory requirements, including claims timeliness guidelines to ensure claims are processed accordingly. HealthSmart MSO is able to specifically customize clients payments based on the clients Health Plan contracts, provider contracts, member eligibility and member benefits.

Our state of the art claim system is able to log, adjudicate and pay claims. Our system automates most of the processing to allow greater accuracy and faster claim turnaround time. Our systems are able to read the information and automatically load it into our claims system.

HealthSmart MSO has the capability to receive claims electronically through our partnership with Office Ally or using an 837 electronic format for direct inloads from our FTP site. In addition, HealthSmart MSO uses its own remote access claim system (“HealthSmart Web”) and our Practice Management Module that allows Providers to submit claims electronically for even faster claims turnaround time.
HealthSmart MSO remote access system allows providers to review the status and history of their claims and payment online for quick and easy access. The integrated data loading capabilities of HealthSmart MSO claims systems allows our claims processors to manually enter only a minimal amount of data, which maximizes daily production.

Our claims staff actively pursues recoveries on behalf of our clients. Most importantly, our Claims Department is committed to providing timely and courteous Customer Service Responses. Our payment turnaround times consistently fall within accepted industry benchmarks, and we conduct back-end claims audits to avoid overpayment of claims and ensure that each claim is paid according to contracted rates. HealthSmart MSO supports in-house recovery procedures to identify and recover lost money on insured services, reinsurance, overpayments, Third-party liability, coordination of benefits, and retroactive terminations.

Providers may submit claims to HealthSmart MSO through the following methods:

• Hard Copy of CMS 1500/UB04/PM160

                 Claims would be mailed to:
                 P.O.Box 6301
                 Cypress, CA 90630-6301

• Electronic via Office Ally:

                 Payer ID Code:  HSM01
                 To Set up Office Ally Please contact Gloria Chung
                 949-464-9129

• Electronic via 837 format to HealthSmart MSO:

                 Please contact your assigned Provider Service Representative at
                 714 947-8600 to set up your account.

• Electronic via Web Portal to HealthSmart MSO Website:

                 Please click here to download your application for Web Portal use:

For a listing of the California Medi-Cal Rates, please refer to:
http://files.medi-cal.ca.gov/pubsdoco/rates/rateshome.asp

For a listing of the Medicare Rates, please refer to:
http://www.palmettogba.com/

For a listing of the CalOptima Rates, please refer to:
http://www.caloptima.org/codManuals/cod/443_cod.htm