Welcome to Nextcare! We are here to guide you through the process of obtaining prior authorization, and identifying healthcare providers within your network. To effectively apply for a preauthorization, here are some steps you can follow:
Find healthcare providers within your network:
Please refer to the list of network providers offered by your insurance company, or access it via our Lumi app. If you require further assistance, feel free to contact our care center agents.
Check your eligibility for the service:
Please review the list of benefits available to you through our Lumi app , or contact our care center agents on +961 1 504000, or WhatsApp +961 81 504015 from 8 am to midnight. Alternatively, you can also contact us through the “Need Help” section on the mobile app, or refer to your insurance company for more information.
Emergency Admission:
Emergency admission refers to a health condition sustained as a result of sudden sickness or injury raising a legitimate professional concern that there may be a significant medical problem necessitating treatment (medical or surgical) which cannot be delayed and which requires immediate confinement to a facility followed by hospitalization or not.
In the case of an emergency, please do the following:
• Immediately go to your preferred covered hospital facility.
• Present your digital insurance card from the Lumi app, or present your physical insurance card along with a valid identification.
The healthcare provider will contact Nextcare for evaluation and claim adjudication. Once the claim is approved, Nextcare would deliver the authorization directly to the hospital.
Inpatient Non-emergency Admission:
When an insured member or individual requires medically necessary treatment that involves an overnight hospital stay or admission as a day care patient, it is referred to as an Inpatient Non-Emergency Admission. Inpatient Precertification, on the other hand, is the preauthorization process to determine if the medical or surgical management, including diagnostics and treatment, meets the criteria for medical necessity under the member’s benefit plan.
It is essential for the member to obtain prior approval before proceeding with a medical service. Nextcare offers you multiple ways to submit the necessary documents:
• Front desk at the field offices during Nextcare representative’s working hours
• Providers using an online system
• Fax Management system +961 1 498323
To ensure a smooth process, please make sure to submit the following necessary documents:
• Detailed medical report/MRA dated, signed, and stamped by a licensed physician
• NSSF pre-approval when required
• Copy of the insurance card
• Copy of the identification card
• The results of the related procedures (e.g., lab test, X-ray, CT scan, Ultrasound, MRI, etc.)
• The name of the provider
• The admission date
After submitting the documents, the healthcare provider will contact Nextcare for assessment and claim processing. Upon approval, Nextcare will directly forward the necessary authorization to the hospital.
On the day of admission, please ensure you have your ID card and NSSF pre-approval (if applicable). It is essential to notify the hospital staff that you have secured authorization for the scheduled procedure.
Ambulatory Service:
Ambulatory service is when an insured member or person receives necessary medical treatment from a healthcare provider that does not require an overnight stay in a hospital or admission as an inpatient or day case patient. Examples of ambulatory services include diagnostic tests and procedures, laboratory tests, radiological tests, and physiotherapy.
We have simplified the process of obtaining a pre-approval directly from your preferred covered medical facility. All you need to do is submit the following documents:
• Unified prescription adequately filled mentioning full name, date of birth, the diagnosis or motive for the tests, dated, signed, and stamped by a licensed physician
• NSSF prior approval, when applicable, for tests requiring NSSF prior approval such as MRI, CT scan, physiotherapy, etc.
• Copy of the insurance card
• Copy of the ID
After you have submitted the documents, the healthcare provider would contact Nextcare for evaluation and claim adjudication. Upon approval, Nextcare will then send the necessary authorization directly to the hospital.
Acute Prescribed Medications:
Acute Prescribed medicine refers to medications provided on an Outpatient basis that can only be obtained through a prescription written by a Physician to treat acute conditions.
At Nextcare, we make it easy for you to obtain a pre-approval directly from your preferred covered pharmacy facility. To initiate the process, all you need to do is to provide them with the following documents:
• Unified medical prescription adequately filled mentioning triple name, date of birth, the diagnosis or motive for the prescribed medicine, dated, signed, and stamped by a licensed physician
• Copy of the insurance card
• Copy of the ID
After submitting the necessary documents, the healthcare provider will coordinate with Nextcare for assessment and claim processing. Upon approval, Nextcare will then forward the required authorization directly to the pharmacy.
Chronic Prescribed Medications:
Chronic Prescribed medicine refers to medications provided on a monthly basis that can only be obtained through a prescription written by a Physician to treat chronic and sub-acute conditions.
• For chronic prescription requests, you can submit the Nextcare chronic prescription form to your HR department or email it to pbm-leb@nextcarehealth.com. Nextcare handles these requests on a monthly basis, and once approved, a prescription key with a pre-authorization form (when applicable) would be shared with you by your HR team.
• When presenting the prescription at your preferred covered pharmacy, make sure to have your identification card, insurance card, and prescription key with a pre-authorization form (when applicable) with you. The pharmacist will enter the prescription key on their online system and dispense your medication directly.
Doctor visit:
If you wish to consult with treating physicians using a direct billing process, simply provide your identification and insurance cards upon arrival at the clinic. The clinic staff will guide you by entering your card details or other relevant identifiers into an online system. In specific situations, Nextcare may necessitate a pre-authorization to confirm medical eligibility.
Ensuring your peace of mind is our top priority. That’s why our Care Center department is available 24/7, ready to assist you. Whether you have questions, concerns, or need immediate support, our dedicated team is just a call or message away. Reach out to us at +961 1 504000 or send a WhatsApp message to +961 81 504015 (8 am to midnight).
You can also connect with us conveniently through the “Need Help” section in the Lumi app. Our team is always available to address your concerns and answer your questions. Furthermore, you can email Nextcare for any concerns or complaints at membercare_leb@nextcarehealth.com”
To know what you have to do after settling a healthcare service and looking to reimburse the settlement, Click here.
