SERVICES

NEXtCARE has strict and enforceable rules and procedures when implementing operations related to Fraud & Risk Governance. It applies a two-pronged approach to lessen system abuse, the first dealing with fraud prevention and the second with fraud detection. Our Anti- Fraud Strategy uses continuous risk assessment and control evaluation tools to ensure compliance standards are adhered to when managing medical providers, and services are supported with proper monitoring and reporting.

With prevention procedures, NEXtCARE implements fraud controls and recovery clauses, anti-fraud awareness and training, and enters into renegotiations, terminations and recoveries. As rigorous are our detection best practices, involving eligibility checks, system alerts, business intelligence enabled dashboards, data mining, data analysis and field audits.