Call Centre: Claims Management:

• 24/7 regional coverage • 24/7 precertification, concurrent &

• 100% proprietary without outsourcing retrospective review
• Multilingual medical staff • Clinical guidelines and second opinion review
• Leading edge technology • World-wide direct billing
• Quality management KPIs • Case management & utilization review
• Regulatory compliance

1 Multi-Lingual 24 Hour 2 24 Hour Medical 3 Pre-Certification, 4 Case Management &

Call Centre Claims Management Concurrent and Utilization review -
Retrospective Review Second Medical Opinion
NEXtCARE operates a 24-hour, 7 day-
NEXtCARE’s call centre operates 24 hours
a-week claims department staffed
per day, 365 days per year and is staffed NEXtCARE applies pre-certification and Complimentary to network anti-fraud
exclusively by medical doctors. This
by medical call centre experts. The Call comprehensive management for each measures, NEXtCARE’s claims department
medical advantage allows enhanced
Centre provides NEXtCARE partners a in-patient and emergency admission as conducts regular case management &
communications with providers and
specialized central point of contact for any well as selected outpatient procedures and utilization review of inpatient cases that
members as well as facilitates faster and
questions or requirements ranging from services. NEXtCARE’s focus is to ensure meet specific clinical criteria. As part of its
more accurate claims management.
medical referrals to benefit clarification, that each member receives clear eligibility claims management approach, second
coverage information and other queries. information and case review for medical opinion review is an additional service
necessity and cost-appropriateness. provided to specific in-patient cases
which focuses on extending free second
opinions to ensure medical necessity and
appropriateness of care.

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