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Information Center
Welcome to our download center. Here you’ll find NEXtCARE Documents, Forms and Information for various business areas and topics.
NEXtCARE Lebanon - Medical Report for Admission
FAQs
Q Is NEXtCARE an Insurance Company?
ANEXtCARE is a TPA (Third Party Administrator) and not an Insurance company. NEXtCARE
specializes in providing complete health insurance management and third party administration services for insurers and other payers of healthcare.
Q How to submit a reimbursement claim online?
A
You can submit a reimbursement claim either through the NEXtCARE website www.nextcarehealth.com or through the Mobile App available on Google Play and Apple Store.
 
a.    Go to MyNEXtCARE
b.    Register or log in through your user name and password
c.    Go to “Claims”
d.    Go to “Submit New Claim” and make sure you have on hand the following:
           - Complete details such as the healthcare provider name, service date and description and the physician name.
          -  All necessary supporting documents, including the medical report, itemized bills and original receipts.
 
Since required documents differ from one country to another and from one service type to another, for a complete list of required documents, please check “What are the required documents to submit a Reimbursement Claim?” 
 
After completing all required information, follow these steps:  
a.    Complete your claim information
b.    Upload or capture all required supporting documents
c.    Click "Submit Claim" to complete the process
 
After you submit your completed claim form, you will receive a notification by e-mail to confirm that it has been submitted successfully.
 
 
Q How can I find a Hospital, Diagnostic Center, Pharmacy or Doctor?
AYou may search for a healthcare provider through the NEXtCARE website www.nextcarehealth.com or through the Mobile App available on Google Play and Apple Store:
 
Website
•        Go to www.nextcarehealth.com
•        Go to “For Healthcare Providers” section
•        Go to “Healthcare Provider Partners”
•        Search for a Healthcare Provider by Name, Country, City, Area, Type and Network
 
Mobile App
•        Register to MyNEXtCARE or Log in through your user name or password
•        Go to “Network”
•        Search for a Healthcare Provider by Name, Country, City, Area, Type and Network
•        You can also locate providers near your home, work or the nearest based on your current location.
 
 
Q What do I do in an emergency?
APlease contact our local Call Center number available at the back side of your insurance card so we can provide assistance and clarify procedures. 
Q How do I arrange direct settlement for planned in-patient treatment?
A
  • Member visits the provider and consults with the physician.
  • Provider will submit the request for elective in-patient services via web, email or fax. 
  • Claim is adjudication is done as per policy terms and conditions.
  • Provider is replied back with the decision on claim within 24 hours for elective case.
  • Provider receives the decision from NEXtCARE and informs members accordingly to plan the date and timings of service/s to be provided.
Q How can I follow up on my reimbursement claim?
AYou can easily follow up on your reimbursement claim either by using My NEXtCARE or by calling the Call Center number on the back side of your insurance card.
Through My NEXtCARE, go to Claims, View Claims page and you can Search for any submitted reimbursement claim to know its status:
  • If the status is Pending for Beneficiary Response, it means that the claim was received by NEXtCARE team and some mandatory documents are missing.
  • If the status is Registered, it means that the claim was submitted to NEXtCARE but not yet reviewed by NEXtCARE team.
  • If the status is Authorized, it means that the claim was reviewed by NEXtCARE team.
  • If the status is Processed, it means that the claim was reviewed, totally / partially approved by NEXtCARE team and ready for settlement.
  • If the status is Settled, it means that the claim is settled.
  • If the status is Declined, it means that the claim was denied since you are not eligible as per your insurance policy terms and conditions.
  • If the status is Not Used, it means that the claim was authorized but has not been used.
Alternatively, you can send a message through My NEXtCARE, Submit Inquiry page.
Q What if I have lost my Insurance Card?
AGo to Lost Card page, add your comments in the “Comment“ text box and click on “Submit“ to submit your request to NEXtCARE team. 
Q How can I submit an Inquiry or a Complaint?
A
Go to Contact Us, Submit Inquiry page, select the “Reason of Inquiry“, add your comments in the “Comment“ text box and click on “Submit“. NEXtCARE Customer Service Team will revert within the maximum of 48 hours. 
Q What are the required documents to submit a Reimbursement Claim?
AWe encourage you to submit a Reimbursement Claim online either through the NEXtCARE website www.nextcarehealth.com or through the Mobile App available on Google Play and Apple Store.
 
The documents required to submit a reimbursement claim differ from one country to another and from one service type to another as defined in the table below: 
Document Type Service Type Country Description
Reimbursement Claim Form In Patient
Out Patient
Medicine
Consultation
Dental
Optical
GCC
Lebanon
Egypt
Tunisia
Claim Form completely filled in and signed by you and stamped by the Attending Physician.
For Dental treatments, please ask the Dentist to mention the number of the affected teeth with the corresponding service done on each tooth. 
Detailed Medical Report  In Patient
Out Patient
Medicine
Consultation
Dental
Optical
GCC
Lebanon
Egypt
Tunisia
A detailed report completed and signed by your Attending Physician and stamped by the Service Provider. The report should include: the history of the present illness, the past medical history, the clinical history and the prescribed medical tests and/or medicines.
Medical Results  Out Patient GCC
Lebanon
Egypt
Tunisia 
Your laboratory test results, radiology reports, etc… as provided by the Healthcare provider.
Detailed Invoice In Patient
Out Patient
Medicine
Consultation
Dental
Optical
GCC
Lebanon
Egypt
Tunisia
Your healthcare provider bill that lists all the services itemized you received and the total amount for each.
For dental treatments, please ask the Dentist to mention the number of the affected teeth.
Discharge Summary In Patient GCC
Lebanon
Egypt
Tunisia 
A clinical report prepared by your Attending Physician at the conclusion of a hospital stay or series of treatments. It should include your diagnostic findings, the therapy administered and your response to it, intra-operative notes and findings if surgery was carried out and recommendations on discharge.
Prescription Medicine
Optical
GCC
Lebanon
Egypt
Tunisia 
Prescription signed and stamped by the Attending Physician and the Service Provider.
For Egypt cardholders, a Pharmacy stamped invoice is also required.
Medication boxes stamped by the pharmacy
(when applicable to be presented to the Payer upon Cheque reception)
Medicine Lebanon
Tunisia
For Lebanon cardholders, your prescribed medication boxes that were stamped by the Pharmacist during the purchase.
For Tunisia cardholders, the prescribed medications price labels (vignettes) or the leaflets (prospectus) if the price label is not available. If both are not available, a stamp from the Pharmacist “Sans vignette, sans prospectus” is required.
Copy of your Insurance Card In Patient
Out Patient
Medicine
Consultation
Dental
Optical
GCC
Lebanon
Egypt
Tunisia 
A scanned copy of the front side of your Insurance Card.
Copy of your Identity Card In Patient
Out Patient
Medicine
Consultation
Dental
Optical
GCC
Lebanon
Egypt
Tunisia 
A scanned copy of your Identity Card or Passport.
Social Security Forms & detailed invoice In Patient
Out Patient
Medicine
Consultation
Dental
Optical
Lebanon
Tunisia
Applicable only for Insured Members who have the National Social Security Fund coverage and who are seeking a complementary treatment.
Social Security forms should be filled as per the Social Security rules by your Treating Physician. 
Copy of the Passport Pages and Airline Ticket In Patient
Out Patient
Medicine
Consultation
Dental
Optical
GCC
Lebanon
Egypt
Tunisia
Applicable only for treatments / services outside the country of residence.
A copy of the Passport pages showing the Exit/Entrance Date from/to the country of residence as well as a copy of the airline ticket related to the same trip.

 

Q How do I read my insurance card?
AYour insurance card is issued by your insurance company to help you benefit from direct billing services at healthcare providers.
It is for your personal use as it summarizes your insurance policy and it must be presented whenever you visit a healthcare facility.
The insurance card format usually differs from one insurance company to another and from one policy to another; however, some of commonly used terms are:

Card No  is the 16 digits number printed on the front side of the card. This number is generated by NEXtCARE as your personal unique number which would be used for all your transactions.
Network  is a code that represents a group of healthcare facilities (hospitals, clinics, laboratories, pharmacies, etc.) contracted NEXtCARE allowing you to benefit from direct settlement of bills.
For more information about your network, visit the Healthcare Providers Partners’ page on www.nextcarehealth.com
Ded: Deductible
Co-Pay: Co-payment
Co.Ins: Coinsurance 
represents the amount you have to pay for the healthcare provider as your share of the claim.
This number can be either a percentage of the claim cost or a predefined flat amount.
Category  is a code that represents your insurance policy eligibility and table of benefits. 
Class  defines the room you are entitled to have in case of hospitalization.
Effective Expiry  represents the starting and ending dates of your insurance policy.
Optical
Dental
Maternity
are your additional benefits. If No is mentioned on the card, it means that you are not entitled for these benefits.

 

Q Can I visit a provider outside my network?
A
Yes you can only if as per your Insurance Policy Terms and Conditions you are allowed to use a non-network provider for eligible services. However, this is not recommended as you will be required to pay all bills and then claim back eligible amounts.
To submit a Reimbursement Claim, please go to Claims, Submit a Claim page.
Q What is a Network Provider?
A
Network Providers are healthcare facilities (hospitals, clinics, laboratories, pharmacies, etc.) contracted with NEXtCARE allowing you to benefit from direct settlement of bills only by presenting your insurance card.
To see the list of Network Providers you are allowed to use, check your insurance policy or go to Network page. 
Q Who is NEXtCARE?
ANEXtCARE is one of the leading “Third Party Administrators” (TPA) for the insurance industry in the GCC & MENA region.
NEXtCARE is specialized in providing complete health insurance management and administration services to insurers and other healthcare payers providing the perfect balance between the best customer service and the maximum cost optimization in addition to compliance with regulators.
For more information about NEXtCARE, please visit www.nextcarehealth.com
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