FAQs

We are pleased to provide you answers to some of the most commonly asked questions.
Is NEXtCARE an Insurance Company?

NEXtCARE 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.

How to submit a reimbursement claim online?

You can submit a reimbursement claim either (download here) through the NEXtCARE website www.nextcarehealth.com or through the Mobile App available on Google Play and Apple Store.

 

  1. Go to MyNEXtCARE
  2. Register or log in through your user name and password
  3. Go to “Claims”
  4. 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:

  1. Complete your claim information
  2. Upload or capture all required supporting documents
  3. 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.

How can I find a Hospital, Diagnostic Center, Pharmacy or Doctor?

You 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 “Healthcare Network” section
  • Search for a Healthcare Provider by Name, Country, City, Area and Type

 

 

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.
What do I do in an emergency?

Please contact our local Call Center number available at the back side of your insurance card so we can provide assistance and clarify procedures.

How do I arrange direct settlement for planned in-patient treatment?
  • 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.
How can I follow up on my reimbursement claim?

You 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.

What if I have lost my Insurance Card?

Go to Lost Card page, add your comments in the “Comment“ text box and click on “Submit“ to submit your request to NEXtCARE team.

How can I submit an Inquiry or a Complaint?

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.

Can I visit a provider outside my network?

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.

What is a Network Provider?

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.

Who is NEXtCARE?

NEXtCARE 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