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Change Can Be Difficult - Even for Your Providers

In January 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 your providers. 

To help 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. 

We described 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. 

Most 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. 

Please 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.


 
MANAGING RISKS AND PROMOTING WELLNESS FOR MORE THAN 160 ILLINOIS PARK DISTRICTS, SPECIAL RECREATION ASSOCIATIONS, FOREST PRESERVE DISTRICTS AND CONSERVATION DISTRICTS SINCE 1984.
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