HealthTrio Smart Connect Provider Portal Now Includes InterQual Connect

InterQual Connect, the cloud-based, automated medical review and connectivity solution from Change Healthcare, is now available within the authorization module of HealthTrio’s Smart Connect provider portal, HealthTrio announced today. This integration allows providers using the Smart Connect portal to perform an InterQual medical review during the authorization submission process, which improves quality, decreases time-consuming manual processes, and reduces unnecessary cost for both payers and providers. »

HealthTrio Unbundles Interoperability Solutions

HealthTrio Unbundles Interoperability Solutions

DENVER, CO – May 28, 2016 – For nearly two decades, HealthTrio has connected the many constituents and trading partners necessary for health plans, administrators and the trading partners themselves to conduct business more efficiently and effectively. 

At this 2016 AHIP Institute & Expo, on June 15 – 17, 2016 in Las Vegas, NV, HealthTrio is unveiling its unbundled interoperability solution, Smart Exchange.  »

Data & Partner Integrations

Integrate faster, using less resources

Connecting and exchanging data with your internal systems and trading partners can be expensive and time consuming. Hardware and software costs can be significant. Our SaaS solution with its lower cost to entry reduces IT resource consumption and enables your resources to focus on other technological priorities. »

Smart Exchange

Smart ExchangeA full service, hosted EDI management and partner data integration solution

Meet your virtual EDI management team – managing all hardware, software, maintenance and support

  • Achieve CORE certification for HIPAA transactions
  • X12, HL7, XML, EDI and DICOM standards
  • We perform data mapping, testing, validation, real-time transaction monitoring, and reporting

No hassle integrations

  • We install and manage partner integrations on your behalf, saving your valuable IT resources
  • We connect to any internal system and any external partner
  • We develop cross-system workflows to automate cross-functional business processes

Learn how Smart Exchange minimizes the challenges of interoperability »

Smart Connect

Smart ConnectThe most flexible, action-oriented portal solution in the market

Looking to comply with NCQA member connections?

Need to meet state requirements for cost and quality transparency?

Want to help providers close gaps in care?

Advancing member engagement through mobile access and wellness initiatives?

Ready for live customer chat?

With Smart Connect, you choose.


Smart Record

Smart_RecordA shared health record that supports collaborative care

Customized, dynamic information based on claims data, analytics and collaborative care plans

  • Medications and allergies
  • Conditions, problem lists and progress notes
  • Gaps in care
  • Uploaded lab and test results
  • Remote patient monitoring
  • Provider prescribed health content
  • Mobile-integrated health trackers
  • Innovative permissions put member in control of sensitive data
  • Import and export data in portable CCR/CCD formats

Learn how a Shared Medical Record changes the face of engagement and care collaboration »

Smart Metrix

Smart_MetrixAnalytics for actionable insights into quality, cost, and population health

Smart Metrix reveals opportunities to drive down costs and dig deeper into the data.

Discover root causes, like improper utilization or deviations from best practices, and easily identify outliers and trends with benchmarking and intuitive data visualization. Extend information to providers and drive action through provider portal dashboards and personalized member alerts. »

Who We Serve

Health Plans

Health plans are feeling the squeeze from every direction. Increased pressures on cost, quality and regulatory compliance are shifting the strategies and needs to operate a plan.

Smart Series provides many capabilities to extend the reach and results of Commercial, Medicare and Medicaid plans.  From claims administration through interconnecting your members, provider networks, brokers, and employers, health plans are supported in reducing medical loss and administrative costs.  »

Medicare Plans

In 2016, CMS estimates that the average MA premium will decrease by 1%, even though Part D and Special Needs plans are expected to increase by 8% and 3% respectively. That’s not stopping current or new entrants from offering more MA plans in 2016, including more with zero premium. Further, Star Ratings emphasizing healthy behaviors, managing chronic conditions, and measuring members’ satisfaction with the health plan services and processes remain critically important, with loss of one star costing MA plans millions of dollars. »

Medicaid Plans

In Q2 2015, CMS issued guidance to states for Medicaid MCOs to dedicate a minimum portion (85%) of rates to medical loss – the first significant Medicaid managed care regulation issued since 2002.   NCQA’s Standards for Member Connections and New York’s DSRIP program continually emphasize patient-centered care, services in health education, wellness and prevention, and improved care coordination across an expanded care team that includes community-based organizations. »

Emerging Care Systems

Need Short Header

The growth and evolution of care delivery systems assuming full risk continues to rise rapidly. The formations are many – ACO, DSRIP PPS, MSOs and even more traditional IPAs. Faced with new administrative challenges, population health and care coordination initiatives, the prospect of using EMRs and HIEs to resolve these issues falls flat. »

Provider Organizations

Enable the transition to value-based payment

Pay-4-Performance and value-based payments are becoming the new normal. Regulation and financial incentives are aligning to drive down cost and improve quality of care. Integration of physical and behavioral health are further driving the need for sophisticated care coordination that can’t be resolved through EMRs and HIEs alone. »

Administrators & Trusts

Achieve differentiation amidst expanding customer demands

Self-insured employers and trust constituents have evolved their expectations of plan administration. The enlightened administrator is competing beyond cost to include employee engagement, health and wellness, consumer-driven plans and medical spend reduction.

Smart Series offers comprehensive administration and communication capabilities.

Learn how HealthTrio can differentiate your administrative offerings »

America’s Health Insurance Plans (AHIP)

America’s Health Insurance Plans (AHIP ) is a national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. Our member companies offer medical insurance, long-term care insurance, disability income insurance, dental insurance, supplemental insurance, stop-loss insurance and reinsurance to consumers, employers and public purchasers. »


At Casenet®, we believe all individuals should be able to achieve maximum health with the right coordinated health management. We deliver unmatched flexibility to coordinate care management programs using our comprehensive and extensible, enterprise care management platform – TruCare®. TruCare includes case, disease, utilization and home and community-based services management as well as online and mobile tools for individual health and total population management. »

Change Healthcare

Change Healthcare is inspiring a better healthcare system. Working alongside our customers and partners, we leverage our software and analytics, network solutions and technology-enabled services to help them improve efficiency, reduce costs, increase cash flow and more effectively manage complex workflows. Together, we are accelerating the journey toward improved lives and healthier communities. »


Dell is an end-to-end service provider of IT and business solutions for health plans. Our level of service differentiates us from other companies with a business model that emphasizes listening to and engaging with our customers. We are equipped to partner with health plans, enabling payers to address their strategic vision of being a member-centric organization while remaining competitive in the evolving consumer-driven market. »

Dynamic Healthcare Systems

Dynamic Healthcare Systems, Inc. delivers comprehensive enterprise software solutions and services for health plans with Medicare Advantage, Medicaid, and Marketplace lines of business striving to succeed amid new and evolving regulatory requirements. Headquartered in Irvine, California, the company brings world-class innovations to companies serving the government-regulated healthcare populations. Our deep experience in government healthcare, coupled with a proven track record, makes Dynamic a premier solutions provider that you can count.  »

HealthCare Information Management, Inc. (HCIM)

Since 2000, HealthCare Information Management, Inc. (HCIM) has delivered technology solutions and consulting services to health care payers and managed care organizations.  HCIM’s innovative products augment your existing core claims transaction system and streamline your claims and authorizations operations through business process automation. Our leading edge products greatly improve turnaround times, reduce inventories, and optimize accuracy, which results in a rapid return on investment and significant time and cost savings.  »


HealthDay is a leading producer and syndicator of health news and is the largest syndicator of that news to Internet sites. HealthDay’s news service is helping managed care organizations encourage members to take charge of their health by featuring health tips containing practical advice for living a healthier lifestyle, FDA approvals, as well as helpful news. »


Reach more members with consistent health education from Healthwise. Healthwise solutions extend across the entire care continuum for cost-effective care management and shared decision making. Healthwise products, integrated within HealthTrio Connect, contribute to better outcomes and lower costs. Healthwise, a nonprofit organization, helps people make better health decisions. 1.800.706.9646. For more information, please visit: »


McKesson Corporation, currently ranked 11th on the FORTUNE 500, is a healthcare  services and information technology company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting. »


PaySpan is the market leader in healthcare payment and reimbursement automation, representing more than 700 payers and 700,000 provider payees that deliver care and benefits to more than 94 million covered lives. With more than 25 years of expertise, PaySpan is a trusted source of innovative healthcare solutions that are Empowering the Healthcare Economy®. »

PCG Software, Inc

Virtual Examiner® is a cost-containment software with over 30 million AMA and CMS based rules and 2 million MediCal edits. Virtual Examiner enhances recovery and fraud and abuse detection. Open architecture facilitates customization. Virtual Examiner provides the information necessary for your organization to reach financial success and meet health care compliance requirements. »


PDHI is a technology services organization that licenses the ConXus Platform for delivering workplace wellness and population-health-management programs. ConXus solutions are integrated, flexible, and secure. Built from a single database and common platform, the ConXus Platform provides seamless data integration and a consistent user interface across multiple devices.  The platform supports multiple branding and service-level options. »

RAM Technologies

RAM Technologies is the leading provider of customized enterprise software solutions for healthcare payers.

For over 30 years RAM Technologies has led the way in the creation of superior software solutions for health plans serving Managed Medicaid, Medicare Advantage, Commercial, and Federal Employee Health Programs. For more information, please visit: »


QualMetrix is a leading provider of healthcare analytics and actionable insights driven by the intellectual capital of our team of medical directors and experts. We drive cloud-based solutions driven innovative reports to payers, providers, employers and risk- based entities. Our platform is user friendly, intuitive, and driven to support lower costs, higher quality and client satisfaction. »

Visual Vault

Secure, store, track and connect information across networks, departments, systems and throughout your entire medical enterprise.  Offered as a robust, document content digital storage/retrieval system or a complete Healthcare Information Management platform utilizing workflow automation tools, VisualVault integrates healthcare data with all digital assets—including unstructured data—across the enterprise. »

HealthTrio Launches Smart Series to Streamline Payor Operations

Smart Series logo

DENVER, CO—June 02, 2015 —HealthTrio – the innovator in integrated, Software—as—a—Service business solutions for healthcare organizations – unveiled Smart Series, a series of plug—and—play modules that helps payors run their businesses more efficiently. Smart Series addresses a broad spectrum of a payor’s business needs, including integration and automation, claims administration, care management, collaboration with key stakeholders and analytics. »

Smart Care

Smart_CareFull-featured collaborative management across the care continuum

Smart Care promotes a collaborative process for managing chronic and acute health conditions, creating a member-centric care plan that all providers and caregivers can access.

Robust care management capabilities to manage care and utilization

  • Utilization management – including pre-authorization, concurrent review and discharge planning
  • Case and disease management – managing program enrollment, assessments, referrals, care planning and remote monitoring
  • Mobile capability for home and field-based care
  • Automated communication workflows

Customized programs to meet the unique needs of each population, with specially designed programs for Commercial, Medicaid, Medicare and long-term care, including specific employer group requirements. »