NexgenRx

Step-by-Step Guide to Filing Claims with NexgenRx

1. Determine the Claim Type

NexgenRx supports claims for:

• Drugs: Prescription medications covered under your plan.
• Extended Health Care: Paramedical services (e.g., physiotherapy, chiropractic care).
• Dental Services: Cleanings, fillings, orthodontics, etc.

2. Prepare Required Documentation

• Original Receipts: Must include provider name, license number, service date, and cost.
• Completed Claim Form:
  • Drug/Extended Health: Download the Drug and Extended Health Care Claim Form (English or French)
  • Dental: Use the Dental Claim Form
• Prescriptions/Referrals: Required for specialized treatments (e.g., orthotics, medical devices)

3. Choose Your Submission Method

Option 1: Online via theclaimsXchange® Portal

1. Log in to theclaimsXchange® using your provider credentials.
2. Select “Submit a Claim” and upload scanned receipts or forms.
3. Real-time adjudication provides instant approval/denial notifications

Option 2: Mobile App (NexMobile)

1. Download the NexMobile app (iOS/Android).
2. Use the “Submit a Claim” feature to photograph receipts and submit directly

Option 3: Mail Submission

1. Mail completed forms and receipts to:
   NexgenRx Claims Department
   [Address provided in your policy documents].
2. Include a return address for cheque payments

4. Track and Receive Payment

• Online/Mobile: Check status via the “Claims History” tab on the portal or app
• Processing Time:
  • Electronic claims: Real-time adjudication (immediate results).
  • Manual claims: 5–10 business days
• Payment Methods: Direct deposit (preferred) or cheque.

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FAQ: NexgenRx Claims Process

1. How do I access the claims portal?

Providers and plan members can log in to theclaimsXchange® or use the NexMobile app

2. What is the deadline to submit claims?

Claims must be filed within 12 months of the service date. Check your plan policy for exceptions

3. Can pharmacies/dentists bill NexgenRx directly?

Yes. Over 10,000 pharmacies and 20,000 dental offices are integrated with NexgenRx for real-time claims processing

4. What if my claim is denied?

Common reasons include incomplete forms or exceeded coverage limits. Resubmit with corrections or contact support at 1-888-696-3939

5. Are pre-approvals required for medical devices?

Yes. Submit a Letter of Medical Necessity and pre-authorization form for items like CPAP machines

6. How do I update my banking details for direct deposit?

Log in to the portal → Navigate to “Payment Settings” → Enter new account information

7. Does NexgenRx cover mental health services?

Coverage varies by plan. Check your policy’s “Extended Health” section for psychologists or social workers

8. Can I submit claims for dependents?

Yes. Include their information on the claim form or app submission

9. How do I check my remaining coverage limits?

Use the “Plan Details” section on the portal or app

10. Is there a fee for using theclaimsXchange® portal?

No. The portal is free for providers and plan members

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