Mr. Wissam Mattout, Head of IT, NEXtCARE
January 12 2015
It is no secret that the healthcare industry is becoming more complex. Understanding company health benefits, or even choosing a primary care provider can seem like a daunting task for any individual. If the unthinkable does happen, and an injury or illness occurs, sorting through paperwork to determine what is covered and what is not can add additional stress to any situation.

NEXtCARE, the leading Third-Party Administrator (TPA)  for the Insurance industry in the GCC and MENA region,  works closely with insurance companies to take the guesswork out of healthcare coverage. What sets NEXtCARE apart, says Wissam Mattout,  Head of IT – MEA region, NEXtCARE, is the company’s dedication to leveraging technology to streamline every individual’s healthcare experience.

Third - Party Administrators (TPAs)s process insurance claims for individuals by partnering with health insurance companies. In addition, they  may manage the claims processing, provider networks, utilization review, or membership functions of a number of insurance companies. In short, individuals that use Third - Party Administrators (TPAs) like NEXtCARE can forgo much of the complications that could eventually come along.

Established in 1999, NEXtCARE specializes in providing complete health insurance management and administration services to healthcare payers, including self-insured employers. The company is present throughout the region and operates in 11 countries with four main hubs. With over 700 specialized employees, 85 percent of which are medical professionals, NEXtCARE responds to the needs of over two million insured members and supports a network of over 7,000 providers across the region.

Having regional presence with a global reach, NEXtCARE provides its clients with the perfect balance between unrivalled customer service and maximum cost optimization.  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. “Technology is key to serving our clients in the best  way. We therefore streamline and focus our efforts building  state of the art and unrivalled IT Infrastructure ensuring  high level IT security” says Mattout.  

The aim is to ensure that all NEXtCARE’s specialized employees work together hand in hand in order to address business challenges and map those to the implemented solutions from an IT Infrastructure/Security perspective.

The team prepared an ambitious roadmap, which helped the transformation in NEXtCARE’s IT infrastructure to accommodate and serve the challenging business needs. “Building our private cloud is an expensive but secure solution” says Mattout. For NEXtCARE to ensure the best 24/7 support service through its global reach, the requirement of  a robust, performant and secure  IT infrastructure is a must.

“Accountability” being one of NEXtCARE’s core values, we are committed to establishing and meeting high-performance expectations.  This is reflected through our specialized and highly trained personnel and through our pioneering technologies offering highly sophisticated health insurance benefits management solutions that include the  proprietary web enabled system TATSH ..  TATSH turnkey software is at the core of NEXtCARE’s successful operations. This 360 degree software delivers a cost effective electronic solution to private healthcare schemes by streamlining processes while ensuring competitiveness and profitability. All partners are trained and connected to TATSH in order to communicate, exchange live information and perform transactions online with ultimate efficiency. 

“Putting first things first”, Mattout says. NEXtCARE has an internal online helpdesk system that keeps tracks of all IT inquiries. The current system is available to all IT agents  in order to ensure the best support.

NEXtCARE also provides direct access across various markets for a multitude of products being catered for thousands of providers through TATSH Provider Portal, a web enabled solution called PULSE. This platform allows users to either benefit from PULSE front end or to integrate HIS for eligibility checking, preapprovals claims submissions and reconciliation. PULSE improves efficiency, decreases turnaround time for precertification and manages processing and reconciliation between NEXtCARE and the provider community.

With the goal to provide daily and easy access to data (medical information, lab test and medical claims), and to keep medical history accessible, NEXtCARE has implemented a successful disaster recovery plan. “Our DRS plan is part of the holistic Business Continuity Plan that ensures smooth running of business at all times.

Aligning with our continuous efforts to provide new services and innovations that would deliver better managed care services, MyNEXtCARE, the beneficiary portal, has been designed to provide beneficiaries with “services on a click”. Being the first Third-Party Administrator (TPA) portal serving over 2 Million members, this platform enables beneficiaries to submit their reimbursement claims, view their claims history, find a healthcare provider and access their policy information in the easiest and most convenient manner.
“Maintaining growth in a SMART world is a continuous challenge” says Mattout. NEXtCARE has built an agile and robust IT infrastructure evolving around business and IT transformation. 

“We deal with people’s lives and health. IT security and data confidentiality is our highest priority. With that in mind, all sensitive information is protected, and all data is backed up into a secure private cloud” says Mattout.

NEXtCARE prides itself on its commitment to excellence. In collaboration with our clients, the company views all interactions as an opportunity to build stronger customer relationships through careful listening and proactive solution development.  The NEXtCARE Mobile Application is currently in pilot testing. This application will enable people, whether NEXtCARE members or not, to check public information related to NEXtCARE, our news, health tips, videos and more. Part of the NEXtCARE Mobile Application will be the previously mentioned MyNEXtCARE member interface through smart phones as well.
“It is  a challenging world” says Mattout. NEXtCARE is committed to deliver on the best solutions to support its business and clients. NEXtCARE’s multilingual call center serves the entire region and more 24/7.

Mattout says, NEXtCARE delivers a complete package – from business, to IT, to risk management to consultancy and more.  “We believe in our specialized people and in our pioneering technologies. At NEXtCARE, we are all invested in our IT Infrastructure and committed to its strategy at every department level. 

IT support is an integral part of our business. Innovation, information, and integration are pillars to success. “
With a solid infrastructure in place and constant and consistent innovation and development, NEXtCARE is able to administer custom-designed healthcare plans in response to the clients’ unique requirements, providing them with a competitive advantage. The company is able to mix and match various services with the aim of providing an innovative “Plug and Play” concept which efficiently complements existing products. The result is efficiency and transparency, as well as an entire company that is fluent in technology.
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