providerlookup.healthsmart.comHealthSmart Provider Lookup

Provider Lookup About Us News and Media Vision, Mission, Values Executive Management Events History Careers Visit Us Home Contact Us Disclaimer: IMPORTANT NOTICE: HealthSmart's online provider directory is provided for reference purposes only. While every effort is made to ensure that we provide current, accurate data, provider information changes frequently. As a result, recent changes may not be reflected in the data presented here. HealthSmart recommends that you contact your health care provider directly for the most accurate and up-to-date demographic and participation information. If you are unable to find the provider or specialty you are searching for, you can contact HealthSmart at the toll-free number shown on your ID card. By clicking, "ok" below, you acknowledge that utilization of a provider found on this site is not a guarantee of benefits, and that providers listed in this directory may not be available to all clients due to group-specific network restrictions and/or individual benefit plan requirements. It is your responsibility to: Contact the provider prior to accessing services to verify your new patient status, location and participation in our network. Contact your health plan administrator to verify your benefit eligibility information. STATE SPECIFIC INFORMATION: The States of Arizona, Florida, North Carolina and Texas want our members to know.... Beginning on or after January 1, 2004, for certain group health plans located in Arizona, Texas, Florida, and North Carolina which renew on or after this date, the following procedures are excluded as covered benefits: - Abdominoplasty/Panniculectomy - Bariatric surgery (i.e., Gastric Bypass surgery) - Breast Reduction - Erectile Dysfunction Treatment - Varicose Vein Treatment These procedures and services will be specifically excluded for dates of service on or after the effective date of the group renewal. Please contact your insurance company or plan administrator for additional information. FOR OUR CALIFORNIA MEMBERS - Some hospitals and other providers do not provide one or more of the following services that may be covered under your health plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan phone number listed on your ID card to ensure that you can obtain the health care services that you need. FOR OUR TEXAS MEMBERS - Although healthcare services may be or have been provided to you at a healthcare facility that participates in the HealthSmart provider network used by your health benefit plan, other professional services may be or have been provided at or through the facility by physicians and other healthcare practitioners who do not participate in the HealthSmart network. You may be responsible for payment of all or part of the fees for those professional services that are not paid or covered by your health benefit plan. For more information, please refer to the toll-free number located on your ID card. FOR OUR MASSACHUSETTS MEMBERS - All primary care physicians and specialists are reimbursed on a fee scheduled unless otherwise noted. Definitions for compensation methodologies: Capitation: Provider receives a fixed, age/sex-adjusted, periodic prepayment based upon the members in a Provider's panel. Primary Care Physicians also receive a Quality Enhancement payment for maintaining open panels. Fee Schedule: Provider is paid a fee for each service rendered as billed by Provider. Discount from Charge: Provider receives an agreed upon percentage discount from the Provider's billed charges for services rendered. Per Diem: Provider receives a fixed payment per day of service. Payment amount may depend upon services provided and length of stay. Case Rate: Provider receives a fixe payment for providing services to a member based upon the diagnosis of the patient. Massachusetts hospitals are reimbursed based upon a combination of payment methodologies including Per Diems, Case Rates, Fee Schedules, Discount from Charges, and Capitation. Legal Notice: The providers available through this application do not necessarily reflect the extent of HealthSmart's network of participating providers. There may be providers which are not listed in this database that are part of HealthSmart's network, and the availability of any providers listed herein is subject to change without notice. Providers may be contracted under different tax identification numbers and therefore, you should contact the provider directly to confirm participation in the HealthSmart network. HealthSmart does not accept any responsibility or liability for damages arising from the use or reliance on this information. The HealthSmart network is not an insurance company or claims administrator, and thus, we do not pay claims, determine eligibility, or make benefit determinations. As such, you should contact your health care insurer or plan administrator to verify your benefit information and availability. The participating providers listed in this database are independent contractors, and are not agents or employees under the control of HealthSmart. By using our Provider Lookup, you acknowledge and agree that the information contained herein belongs exclusively to HealthSmart pursuant to federal and state law, and HealthSmart reserves the right to take any civil, criminal or equitable action to enforce the terms of use described herein. By offering our Provider Lookup feature, HealthSmart in no way endorses the use of a particular provider or health care professional's suitability for your medical needs. I acknowledge that I received and read the disclaimer above. HealthSmart Preferred consists of all of HealthSmart’s owned networks known as HealthSmart Preferred Care II, LP; HealthSmart Preferred Network II, Inc.; and SelectNet Plus, Inc.; and its owned networks formerly known as The Emerald Health Network, Inc.; Interplan Health Group, Inc., Preferred Plan, Inc.; Physicians Direct Network, Inc.; Accountable Health Plan, Inc.; DirectCare America, Inc.; Plains Health Network, Inc.; Northwest One, Inc.; MMHP; Primary Health Services, Inc.; and North Texas Health Network, Inc. including its products known as HealthSmart GEPO and HealthSmart High Performance Plan. 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