2019, PDRMA Health changed to HealthSmart, a new PPO plan third-party
administrator (TPA). Not only does that change mean you need to become familiar with different processes, but so do
answer some of your questions we created the FAQ - 2019 HealthSmart TPA document including a brief explanation
of what TPA changes to expect and that your prescription coverage and network
(Aetna ASA) remain unchanged.
how to read your new explanation of benefits in the HealthSmart EOB Explanation. And we developed 2019 HealthSmart Subscriber Tips, outlining how to access online
claim information, request an ID card and help providers' offices understand
the TPA change.
recently, we created the HealthSmart Claim Filing Participant Aid
that suggests solutions to ensure your providers' billing offices correctly submit
your claims to HealthSmart and confirm your coverage.
continue to use these documents to better understand - and explain - the change
to HealthSmart. If you need additional help resolving claim processing issues
or have questions about these changes, please contact the PDRMA Health Program
Team at 630-435-8998.