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Table of Content

1 Overview 4

2 Why NEXtCARE 10

3 Corporate Governance 14

4 Innovation 18

5 Risk Management Solutions 24

6 Managed Care Services 28

7 Partner Care Services 34

8 Additional Services 38

NEXtCARE is not an
9 Where to Find Us 42 Insurance company.

NEXtCARE provides
Insurance Management Services.

3
 1 Overview

NEXtCARE is the leading Third Party Administrator (TPA) for the Insurance industry in
the GCC & MENA region.

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Established in 1999, the company
specializes in providing complete health
insurance management and
administration services to healthcare
payers including self-insured employers.
Having regional presence with a global
reach, NEXtCARE provides its clients with
the perfect balance between unrivalled
customer service and maximum cost
optimization. This is further asserted
through being a member of the
renowned Allianz Global Assistance,
the international leader in assistance and
travel insurance services.
NEXtCARE prides itself on its ability to
administer custom-designed healthcare
plans in response to the clients’ unique
requirements, providing them with a
competitive advantage while supporting
the ever-changing legislative landscape
of the private health insurance market.
The company is able to mix and match
various services with the aim of
providing an innovative “Plug & Play”
concept which efficiently
complements existing products.
Our Commitment
NEXtCARE drives efficiency through
its large platforms that run one of the
region’s first 24/7 medical and
multilingual call center for a direct and
partner network. Operations in the
company are supported by strong IT,
Compliance, Legal, Communications,
Business Management, Market
Management, Quality Assurance and
Auditing teams that ensure smooth and
outstanding performance.
Risk Management and Mitigation is
crucial for the company which invests
greatly in creating Disaster Recovery and
Contingency Sites that extend peace of
mind and tranquility to its clients.
Customers:
By putting the customers first and empathizing, we see the future through
their eyes; we conduct continuous evaluations to improve quality, service
and commitments towards our customers.
Innovation:
We always keep in mind that we need to change and adapt to create
faster, simpler, smarter solutions as well as deliverance of services
anticipating our customers’ needs.
Accountability:
Keeping our word is paramount to qualities leading to success both on an
individual and team basis. We are committed to establishing and meeting
high-performance expectations.
Reliability:
Consistently practicing ethicality, honesty and fairness in all situations is
important to maintaining a healthy environment.
One Unit, One Family:
An equal amount of respect, dignity and common courtesy to all within
our multicultural organization
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Key Strength
NEXtCARE combines unmatched flexibility, leading information systems and tailor-made
managed care solutions to help clients manage medical expenditures, ease administrative
burdens and promote optimal member satisfaction of their healthcare plans.

• 700 specialized employees, 85% of which are

medical professionals

+80 +4 MN • Expanded reach into all GCC and MENA countries – with
Global Direct Billing facilities
payers of healthcare services, medical claims
both insurance companies and processed each year.
self-funded groups • Access to specialized and highly trained Customer
Service personnel
+700 Facts and Figures (Graphical)

+2 MN employees; 85% medical

insured members
served within the GCC and MENA
region with 24/7 call centre.
+650 MN USD
claims under management
annually which is equivelant to
1 Billion USD of Premium.
professionals.
• State of the art Managed Care Services
• Latest technologies through transparent
Largest regional network with insurance management solutions that
credentialed and contracted include the proprietary system
provider facilities in vari-
ous countries including major
TATSH and the provider portal
PULSE.
hospitals, physician offices, clinics,
diagnostic centres, laboratories,
radiology facilities, pharmacies, • Regulatory Compliance
physiotherapy centres, dental
centres, optical facilities.
and alternative medicine.

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 2 Why
NEXtCARE

WE RELY ON YEARS OF EXPERIENCE IN THE HEALTHCARE MANAGEMENT SERVICES.

So, YOU CAN RELY ON US.

11
 Member of Allianz Global Assistance:
• International Standards
• International Code of Ethics
• Global Reach
International standards with
local expertise
Being a member of the renowned
Allianz Global Assistance, NEXtCARE
benefits from applying international
standards of business management
through embracing the stringent
mandates of compliance and code of
ethics. The company leverages on
nearly 2 decades of expertise in the local
market which augments its proficiency
merging global standards with local
competence.
Global Reach
NEXtCARE provides its clients with global
direct billing through its worldwide
network. The company is enrooted in
the regional market with reach into more
than 14 countries and at the same time
provides its clientele the ability to tap
into any country, anywhere, anytime.
NEXtCARE Provides:
• Efficiency
• Cost Containment
• Expertise
• Focus and Specialization
Industry Meeting Point
NEXtCARE Practices industry leadership
by connecting key influencers –
Regulators, Payers, Providers, Employers
and their Insured Members. Through
its deep understanding of the market
requirements and demands,
NEXtCARE actively engages in forums
and discussion platforms with key
influencers which aim at capitalizing
industry benefits.
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 3 Corporate
Governance

WE RELY ON YEARS OF EXPERIENCE IN THE HEALTHCARE MANAGEMENT SERVICES.

So, YOU CAN RELY ON US.

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Compliance
International guidelines and legisla-
tions are fundamental to NEXtCARE’s
Corporate Governance. The company
acts within global and local regulations
to ensure compliance with legal frame
works and anti-corruption laws.
These endeavors protect the company
and its clients against reputational risks
through the standardization of policies
and procedures linking them to the
highest standards of business
sustainability.
Code of Ethics
NEXtCARE promotes a culture of honesty
and ethical behavior through
implementing an international Code
of Ethics throughout its various offices
and business units. Stringent rules of
anti-fraud, anti-money laundering and
anti-bribery are applied with continuous
assessments and audits to safeguard
the company and its clients against any
potential breaches.
Transparency
NEXtCARE holds transparency at the
heart of its business conduct.
The company develops innovative
products and implements pioneering
solutions that ensure transparency of
processes and clarity of Data.
At the same time, NEXtCARE abides
with the international World Health
Organization – WHO standards of patient
confidentiality.

NEXtCARE

• Advise Customers, Shareholders and business

partners on the best business conduct.

• Detect and Prevent violations of laws and

regulations through identifying and
managing compliance risks.

• Advocate compliance with regulatory

bodies.

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 4 Innovation

ALWAYS LISTENING, ALWAYS INNOVATING

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NEXtCARE develops innovative solutions to ensure efficiency and transparency.
A fully dedicated team works on developing solutions that enable electronic data
exchange between stakeholders of the industry including insurance and reinsurance
companies, self-insured employers, regulators, health service providers and end-users.

Electronic Fund Transfers- EFT TATSH

Focusing on efficiency and transparency,
NEXtCARE has introduced Electronic
Fund Transfer – EFT Solution,
the automated fund transfer system
which streamlines payments for all
provider and payer transactions.
NEXtCARE delivers EFT payment to the
providers within 48 hours of receiv-
ing funds from a payer. EFT eliminates
cheque fraud and provides better
services to the clients through
transparent transactions, minimal
turnaround time, live visibility and
maximum efficiency.
NEXtCARE’s proprietary TATSH turnkey
software is at the core of its successful
operations.
This 360o software delivers a
cost-effective electronic solution to
private healthcare schemes by
streamlining processes whilst ensuring
competitiveness and profitability.
Internet communication technology is
leveraged and all partners are trained
and connected to TATSH in order to
communicate, exchange live information
and perform transactions online with TATSH delivers a complete array of online capabilities which allow payers and
ultimate efficiency. An intuitive graphical reinsurers alike to link into NEXtCARE’s 24/7 operations. System users have
interface links users through the internet real time access and retrieval capability to online policy management and
to the TATSH software which runs on a production modules, claims processing, account management, receivables
highly-available technology platform control, on-line statistics retrieval, actuarial reporting, reinsurance and robust
utilizing Oracle database and Microsoft data transfer ability.
products. TATSH provides NEXtCARE
clients with unmatched transparency
and insight into the management of their
healthcare portfolio.

Advantages of EFT: TATSH Provides:

• Transparency • Live & Realtime Infomation

• Compliance • Granuality
• Payments Expediency • Accuracy
• Sustainability
• Efficiency

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TATSH Payers Portal
TATSH Payer Portal provides the Payers
with all the necessary capabilities to
effectively take greater control of their
own Health Insurance portfolio:
• Product Design & Coverage
Customization
• Premium Structure & Computation
• Reinsurance Agreement
• Endorsements – Addition, Deletion
& Cancellation
• Suspend & Resume coverage per Policy
• Policy Renewal Management
• Claims Activity Reporting, Inquiries
& Profiling
• Technical Results Reporting
• Data Transfers – from TATSH to the
Payer’s System & vice-versa
TATSH Reinsurers Portal
TATSH Reinsurer Portal provides the
Reinsurers with all the necessary
capabilities to effectively monitor the
performance of the reinsured Health
Insurance portfolio including:
• Monthly Reinsurance Reports
• Access to all the Reinsurance
Agreements with Payers
• Claims Activity Reporting, Inquiries
& Profiling
• Technical Results Reporting
• Data Extraction for further analysis
TATSH Provider Portal –
PULSE
TATSH Provider Portal – PULSE improves
efficiency, decreases turnaround time for
precertification and manages processing
and reconciliation between NEXtCARE
and the provider community.
PULSE grants healthcare service Providers
all the necessary capabilities and features
to effectively manage their claims
lifecycle:
• Member Eligibility Verification
• Claims Registration & Precertification
process
• Electronic Claims submission
• Medical services automatic re-pricing
• Documents Checklist for appropriate
claims filing
• Claims inquiry and tracking capabilities
• Reconciliation
• Paid Claims Statement
• Communication Inbox
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 5 Risk
Management
Solutions

WE RELY ON YEARS OF EXPERIENCE IN THE HEALTHCARE MANAGEMENT SERVICES.

So, YOU CAN RELY ON US.

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Safeguarding Information and Data is crucial to the success of any Organizational
NEXtCARE Identifies Risks and Assesses their Business Impact then supports Plans and
Products which are intended to be implemented by Risk Carriers.

Business Continuity Planning Underwriting Tools

and Management
NEXtCARE protects client data through
professional business continuity
planning. The company’s corporate
guidelines identify exposure to internal
and external threats and provide
effective prevention and
disaster recovery solutions for the
organization. Using redundancy and
back-up of all databases and servers,
NEXtCARE maintains high availability,
data security, and data integrity of our
client data.
Further asserting the importance of Risk
Management, NEXtCARE provides an
automated underwriting tools that allow
Payers to:
• Define proposed risk units
• Set parameters for coverage eligibility
per plan
• Set corresponding Premium Tables
• Choose from an additional range of
optional automated features to assign
other eventual specific limitations

Through direct access to NEXtCARE’s

integrated management system, clients
have the ability of directly accessing their
corresponding reinsurance account.
Contingency Site
NEXtCARE invests in contingency plans
and solutions to maintain its
operational performance in times of
various risks. A fully fledged contingency
site is ready to be up and running in case
of any unexpected crisis. This secondary
site guarantees the resumption of work
within a minimum set timeframe.

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 6 Managed Care
Services

WE RELY ON YEARS OF EXPERIENCE IN THE HEALTHCARE MANAGEMENT SERVICES.

So, YOU CAN RELY ON US.

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 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,
NEXtCARE’s call centre operates 24 hours
7 day-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 center experts. The Call comprehensive management for each measures, NEXtCARE’s claims
medical advantage allows enhanced
Centre provides NEXtCARE partners a in-patient and emergency admission as department conducts regular case
communications with providers and
specialized central point of contact for well as selected outpatient procedures management & utilization review of
members as well as facilitates faster and
any questions or requirements ranging and services. NEXtCARE’s focus is to inpatient cases that meet specific clinical
more accurate claims management.
from medical referrals to benefit ensure that each member receives clear criteria. As part of its claims
clarification, coverage information and eligibility information and case review for management approach, second opinion
other queries. medical necessity and review is an additional service provided
cost-appropriateness. to specific in-patient cases which focuses
on extending free second opinions to
ensure medical necessity and
appropriateness of care.

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 5 Impartial Claims
Decisions
NEXtCARE ensures that members are
given balanced and fair decisions related
to their claims coverage and payment.
Decisions are based on eligibility of the
beneficiary and the terms and
conditions of the policy on a direct billing
or reimbursement basis.
6 Claims Processing
NEXtCARE specialises in the detailed
capture of medical services that are
rendered and invoiced by participating
providers for beneficiaries covered under
terms and conditions guaranteed by the
payer.
7 Pharmacy Benefit
Management
NEXtCARE developed its Pharmacy
Benefit Management (PBM) as an
important aspect of claims
management. Member eligibility and
claims adjudication is fully automated
with immediate decision making to
support high levels of customer service.
In addition, NEXtCARE’s PBM
incorporates vendor based solutions to
offer additional system functionalities
such as “drug-drug” interaction edits
which are aimed at preventing
dangerous medication interactions and
saving lives.
8 Confidentiality
With a claims centre staffed 100% by
medical doctors, NEXtCARE knows the
importance of safeguarding patient
confidentiality and medical information.
Patient identification and systems
security are paramount to providing
professional services that NEXtCARE
provides to each of its members.
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International
Coding Protocols
International coding nomenclatures are
embedded in NEXtCARE’s proprietary
web-based system “TATSH” and includes
the International Classification of
Diagnosis, Current Procedural
Terminology, HCPCS, ADA codes, etc.
In addition, NEXtCARE’s TATSH system
allows for multiple versions of individual
nomenclatures to be operated
simultaneously which provides high level
flexibility and compliance capabilities for
country and regulatory requirements.
NEXtCARE also employs full-time
certified coders that oversee on-going
training, quality review and coding
processes.
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 7 Partner Care
Services

NEXtCARE prides itself on its focus to continuous improvement and commitment to With the aim of exceeding expectations in all that we do, we handle both successes and
excellence. In collaboration with our clients, the company views all interactions as an challenges as opportunities to further improve, provide value, and ultimately gain
opportunity to build stronger customer relationships through careful listening and a sustainable competitive advantage within our markets.
proactive solution development.

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1 Partners Relations
With innovation at the heart of all its
service provisions, NEXtCARE moves
away from the traditional triangular
TPA - Client - Supplier model to endorse
a real partnership approach. Leading
industry professionals with 5 to 20 years
of experience act as NEXtCARE market
ambassadors to effectively communicate
and facilitate feedback between
NEXtCARE and its partners.
2 Insurance & Network
Procurement
NEXtCARE offers one of the largest and
most comprehensive provider networks
offering clients extensive direct billing
across the MENA region and various
international locations. With more than
2 million members under management,
NEXtCARE leverages its unique
negotiating position to establish highly
competitive rates which results in
significant cost reductions for medical
services.
NEXtCARE deploys Insurance
Procurement to administer a wide
network of quality healthcare providers
at optimal cost. Insurance Procurement
reinforces efficiency and cost
optimization through ongoing
governance of the contractual
relationship and negotiation with
healthcare providers further utilizing
real-time dashboards, scorecards and
close monitoring.
3 Providers Review
NEXtCARE constantly reviews provider
adherence to contractual obligations.
Trend Analysis, Mystery Shopping
Campaigns, Data Mining, Site Visits and
Medical Records Inspection are ongoing
processes that help eliminate potential
abuse and fraud incidents.
4
Communication
NEXtCARE is Always Listening to its
partners – understanding their changing
needs and delivering structured
innovative solutions that comply with
the shifting requirements.
NEXtCARE Communication Channel
provides consistent and periodical
updates keeping its partners informed
about the latest trends and regulatory
evolutions.
Customer Service
5
NEXtCARE Customer Service
Department liaises with all other
divisions to address any concerns
regarding service delivery.
This department analyses data from
NEXtCARE’s proprietary Inquiry Tracking
System (ITS) to identify trends in client
satisfaction and uses such data to
implement quality improvement
programs. Customer and Supplier
Satisfaction Surveys are also performed
to gain valuable feedback and measure
the quality of service delivery and level 7 Technical
of satisfaction of NEXtCARE’s clients and
providers both locally and regionally.
NEXtCARE goes beyond expectations in
supporting its partners. A team of
experienced professionals is fully
dedicated to conducting Portfolio
6
Operational Dissection, Data Mining, Scheme
Excellence Performance Review and Periodical
Reporting on strategic accounts. This
business intelligence service leverages
Excellence is embedded within partners capabilities by providing them
NEXtCARE’s structure and operational better technical visibility.
model to ensure process optimization.
Project Management specializes in
understanding clients’ needs and
translating them into clear timely action
plans that enable accurate delivery of
objectives. NEXtCARE employs its
expertise in reducing process waste by
extending its services to optimize clients’
in house processes saving them the cost
of long term investment.
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 8 Additional
Services

Attending to the diversified needs of the industry, NEXtCARE offers its partners many with world wide risk carriers, Actuarial and Statistical Review, Data Transfer, Advisory, and
other customized services such as Client Education, Travel Assistance, Training and On-Site Support.
Orientation, Custom-Designed Benefit Materials, Emergency Assistance Services

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 1 Client Education
NEXtCARE offers Client Education
support services on health insurance
benefit design, fraud management and
benefit utilization for payers who are
interested in capitalizing on NEXtCARE’s
claims management experience.
2 Medical Evacuation,
Travel Assistance, and
Travel Insurance
In partnership and underwritten by a
prominent insurance company, travel
insurance benefits can be arranged
through NEXtCARE and Allianz Global
Assistance which provides payers with
the option of offering such benefits
through a leading global carrier. This
unique program offers direct billing for
extensive travel insurance options,
emergency medical evacuation,
emergency travel assistance, repatriation
and other services which alleviate many
of the obstacles and potential expenses
that can be caused by medical
emergencies away from home.
3 Custom Designed
Education Material services to payers for policy development
and Provider Programs
To enhance beneficiary understanding
and prudent use of health insurance
benefits, NEXtCARE supports clients in
the development of member education
materials, health screenings, preventative
health services and seminars which
educate members and deliver high
quality service and support to users of
medical benefit plans.
4 Card Printing and
Policy Intake
NEXtCARE offers custom design and
production of benefit membership cards
which generally bear the branding of
the payer. At policy intake, robust policy
and procedure training is provided to all
contracted providers to ensure that each
card-holding member receives smooth
access at participating network providers
for eligible benefits.
5 On-Site Employee
Benefit Representatives
Supplementing HR and employee
services departments, NEXtCARE can
provide on-site representatives on a full
or part-time basis to facilitate employee
support, ensure service quality and
enhance on-site processing of additions,
deletions, cards issuance, and other
customer service duties.
6
Advisory
NEXtCARE provides optional advisory
which includes product design, pricing
analysis and reinsurance support along
with claims management and utilization
review after product launch. This pro-
vides an ideal partnership opportunity to
improve employee benefits, administra-
tion and performance based on payer
needs and requirements.
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 9 Where
to Find Us

NEXtCARE GROUP supports each NEXtCARE entity and ensures that all operations run
smoothly abiding by the same set of high standards in healthcare management and
delivering the best quality of service.

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nextcare@nextcarehealth.com
www.nextcarehealth.com
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