ADMINISTRATION

NexgenRx uses the latest technology to the maximum extent possible to interface with Third Party Administrators and/or the Plan Sponsor’s plan administrator to ensure efficient and timely administration of their group health and dental benefit plans.

From the outset, with the completion of the Application for Health Benefit Services, the process is highly automated. From system set-up to the generation of a draft of the plan’s descriptive booklet wording, the process is completed within hours. Eligibility data for positive enrollment is accepted in a number of electronic formats and when completed drives the production of Member Benefit Cards. The whole process from signing the Application to getting Benefit Cards into the hands of the plan members can take just a few days. Once approved, booklet wording is available to be posted to the Web, with security, in a highly searchable format. (Professionally printed booklets are an option.)

NexgenRx provides Web access to plan administrators, plan members and market intermediaries (brokers and consultants) for their ongoing administration, claims information and reporting requirements.

Plan administrators are enabled to manage plan eligibility and obtain up to the day management reports on-line. Members may obtain claim forms and, with security, view their claims histories and provide personal information as to existing medical conditions and drug allergies to help ensure the maximum possible safety of new prescriptions. Market intermediaries, with the permission of the plan sponsor, are also enabled to access claims management reports on-line.

NexgenRx’s services incorporate electronic health claims submission by health care providers wherever possible. Where electronic health claims submission is not available, or has not been utilized, plan members will forward all claims documents directly to NexgenRx. If elected, and where possible with appropriate email notice to plan members, health claim payments will be deposited directly to plan member bank accounts via Electronic Funds Transfer (EFT). Otherwise, claims payment are made by cheque.

Electronic communication and EFT is also widely used in the billing process to minimize the amount of money NexgenRx must hold in trust for the plan sponsor to assure the payment of committed claims and incurred expenses on their behalf.

By utilizing the latest technology to the maximum extent possible, NexgenRx is able to provide service leadership at today’s most competitive fee levels.