Claims Center

Our 24/7 Claims Center is staffed with highly skilled physicians and paramedics entrusted with determining members’ eligibility and prompt issuance of treatment authorizations to providers in accordance with the terms and conditions of the applicable coverage as set by the insurers or self-insured groups.

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It also provides members guidance and assistance by answering queries concerning the applicable coverage, providing information about network providers’ locations and specialties, managing their chronic medication needs, and arranging second medical opinions.

 

NAS also proposes a VIP service available to members identified as such by insurers or self-insured groups.

Preferred Provider Network

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REGIONAL NETWORK

NAS offers a carefully selected regional network of participating healthcare providers that includes more than two thousand prominent hospitals, healthcare facilities, diagnostic centers and pharmacies across the GCC region and the Middle East.

 

Participating healthcare providers readily recognize NAS cards and offer members the convenience of Direct Billing access to their facilities, thus eliminating the need for members to pay for their treatment and subsequently to file reimbursement claims.

 

By aggregating the business of participating insurers and self-insured employers, NAS is in a position to negotiate better rates, discounts, rebates and payment terms than what may be obtained by each payer on a stand-alone basis.

 

NAS Network team constantly monitors inflation and pricing trends throughout the region and regularly updates and assists insurers in estimating the resulting impact on their respective loss ratios.

INTERNATIONAL NETWORK

NAS has teamed up with several first-class international Preferred Provider Organizations (PPOs) in order to extend the benefit of Direct Billing access to virtually every hospital world-wide, with particular emphasis on South-East Asia, Europe and North America.

 

This service is supplemented by dedicated hotline numbers available around the clock, and by several travel assistance and medical evacuation options supporting our large and growing portfolio of members eligible for elective and / or emergency treatment abroad.

Claim Processing

NAS offers its customers a comprehensive claims processing solution that covers all stages of the processing cycle starting from receiving claims from providers and/or members to remitting payments to the concerned claimants.

Through its team of highly-skilled professionals, NAS handles all network and reimbursement claims processing functions including application of cost containment techniques, adjustments relating to the coverage conditions of each member, claim burden attribution to insurer / priority payer / policy holder, issuance of payment bordereaux and explanation of benefits, reconciliation with providers, etc.

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NAS is a leader in applying sophisticated automation techniques in order to keep network and / or reimbursement claims turn-around times at a minimum, and has played a key role in making HAAD’s (Health Authority – Abu Dhabi) e-Claim initiative a reality.

At the option of payers, NAS also offers financial services such as maintaining segregated bank accounts and effecting payments to providers and / or members in various currencies for and on behalf of the respective payers.

Claim Settlement

At the end of the Claims Processing cycle, NAS offers its customers, for network and reimbursement claims, issuance of payment bordereaux, explanation of benefits, payment to concerned claimants and reconciliation with providers.

At the option of payers, NAS also offers financial services such as maintaining segregated bank accounts and effecting payments to providers and/or members in various currencies for and on behalf of the respective payers.

Policy Administration

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NAS has a fully dedicated production team that assist customers in their policy administration tasks that include census management, incorporation of policy terms on the system and generation of members’ cards. True to NAS dedication to customer service, turnaround times for cards delivery are among the best in the industry. Cards can be fully customized and designed in accordance with our clients’ specifications and preferences. If required by insurers, premiums are computed and monthly reports generated on the basis of latest production data.

 

Insurers have the option of providing their brokers and insured groups with access to NAS online census management tool that enables the respective parties to manage their group’s additions and deletions.

Integrated IT Solutions

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NAS deploys a state-of-the-art suite of integrated on-line software solutions that support all aspects of healthcare benefits management and comprise various modules that include policy and census management, premium computation and contributions, member eligibility and benefits verification, claims authorizations, processing and adjudication, settlement and reconciliation with providers, financial reporting, and statistics.

All modules support remote access and mobility and incorporate enhanced security features such as user profiling, activity logs and enhanced data confidentiality through dynamic data partitioning.

Through its team of IT professionals, NAS is able to promptly respond to its customers evolving needs and compliance requirements by regulatory authorities, as was recently illustrated by the introduction of ePrescription & eAuthorization services  in the UAE. We have also fully embraced e‑Claim initiatives and have deployed our proprietary JeT on-line portal that has received favorable response from our network providers.

Pharmacy Benefit Management

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In line with our mission statement to provide members with excellent service with a proficient and cost effective solution with no compromise on quality, NAS is proud to introduce a new service in the form of Pharmacy Benefit Management (PBM). NAS has become one of the few TPAs in the region that provides PBM services to its customers.

Pharmacy Benefit Management Program employs innovative technology and clinical expertise to improve claims outcomes and to reduce the total cost of prescription drugs, all while providing the highest level of care for the patient.
We employ a highly efficient and automated technology platform to streamline the pharmacy prior authorization process and improve communication – resulting in improved claims outcomes, increased provider network penetration and lower prescription drug costs.

NAS provides its payers with the complete solution that consists of:

PHARMACY NETWORKS

NAS network of pharmacies provides consumers convenient access to more than 1000 pharmacies in the GCC Region. NAS philosophy since its first operational launch, consisted of nurturing a strong and reliable relationship with quality medical providers including pharmacies (individual and chain) well spread geographically.

 

FORMULARIES

NAS uses panels of independent physicians, pharmacists, and other clinical experts (through a Pharmacy & Therapeutics committee) to develop an approved lists of drugs in order to encourage clinically appropriate and cost-effective prescribing.

 

PREFERRED MEDICINE LISTS

NAS deploys significant clinical and analytical resources to determine the most cost effective and highly efficacious medicines in the top prescribing therapeutic classes. This effort results in a list of Preferred Medicines that will have significant savings for both insurance companies and their members.

 

ELECTRONIC PRESCRIBING (E-PRESCRIBING & E-AUTHORIZATION)

NAS has pioneered the use of cutting-edge e-prescribing technology. Open JeT Application solely designed by NAS provides physicians and pharmacists with clinical and cost information on prescription options that allows them to better inform members on medications that are available to them.

 

MANUFACTURER DISCOUNTS 

NAS pools purchasing power to negotiate substantial discounts from pharmaceutical manufacturers in order to lower benefit costs for clients and consumers.

 

CLINICAL MANAGEMENT

Comprehensive drug utilization review on all prescription transactions and disease management is being done on regular basis to encourage the best clinical outcomes for patients.

 

DRUG UTILIZATION REVIEW

Each and every prescription is screened to prevent dangerous drug interactions, duplication of drug therapy and to check for appropriate utilization.

 

24/7 CALL CENTRE

NAS call centre provides assistance and guidance to patients around the clock.

These building blocks of the PBM program, coupled with our extensive clinical expertise and powerful technology, provide a robust program focused on providing quality care – all the while helping our payers manage the rising cost of medical and pharmacy services.

NAS PBM Services – The right drug at the right time at the right price

Business Analytics Services

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Business Analytics Service at NAS (Analytics) is dealing mainly with data mining trying to discover meaningful patterns and trends to describe, predict and advice on ways to improve business performance; using an advanced infrastructure for generating and analyzing information and associating the most current methods in computer science, statistics and mathematics.

 

Analytics at NAS relies on the simultaneous application of several tools to quantify performance (e.g. Key Performance Indicators), favoring data visualization if meaningful. It uses descriptive and predictive models to gain valuable knowledge from data and data analysis and uses this insight to recommend action or to guide decision making, providing input into operational decisions when needed, on the basis of the analysis.

 

Data Analysis and Reporting at NAS are both part of Analytics. An enhanced platform (replacing or complementing the existing one) is expected to be deployed for all end users in order to make the majority of the reports whether standard or customized accessible online including a superior alerts system.