INDEX

Introduction Nexus in a nutshell Nexus support Nexus explained 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Member administration Contribution management Financial adviser administration Claims processing Managed care Finance Nexus On Call (NOC) Automated communications Imaging and third-party integration Reports Security & access control Self-service & web access 4 6 7 8 10 13 14 16 17 18 19 20 21 2 2 3

Conclusion

Introduction
Welcome to Nexus, the first choice of leading fund administrators and health risk managers seeking a world class integrated healthcare fund administration and managed care solution. Nexus is used successfully by a number of independent healthcare fund administrators to provide various clients (mostly healthcare funds) with their own unique set of rules and requirements, accompanied by service of exceptional quality. Nexus delivers comprehensive healthcare fund benefit management to hundreds of thousands of people across many countries on a daily basis. Although Nexus may be used successfully for any operation that involves large transactional volumes, the system is ideally suited to the healthcare fund and insurance industries as it is essentially a rules-based, user configurable solution specifically designed to support real-time processing. Nexus is optimised for automation and features a sophisticated integrated imaging system as well as proactive communication capabilities. In addition, an annual SAS70 review of the general IT control environment is conducted to ensure system security. Nexus distinctive features are summarised in this brochure, which highlights the unique features of this world-class modular administration platform.

Nexus in a nutshell
Nexus is a state-of-the-art healthcare fund administration solution, offering: Real-time interfacing and processing of transactions. Intelligent, real-time communication to members and healthcare providers. Highly parameterised functionality and customised client set-up. Excellent ongoing client support. Pro-active health risk management through a rules based clinical adjudication system. Fast response times, designed to deal with consistent high volumes of claims transactions. Various clinical classification standards, such as ICD-10 and CPT diagnostic codes.

An overview of the nexus modules

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Nexus support
In addition to delivering a fully integrated healthcare fund administration, managed care and insurance solution, Nexus provides a full spectrum of optional hosting and support services including: A world-class infrastructure on which the system operates. State-of-the-art disaster recovery capability. State-of-the-art data storage capacity. Continuous support and expertise from experienced product development and support teams. Historical data take-on if required. Nexus systems training for new users. 24 x 7 IT support services to ensure optimal system up-time. Continuous research and development carried out by a dedicated team of over 100 full-time Developers and Business Analysts. Regular pdates o nclude unctional nhancements u t i f e and legislative changes.

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Nexus explained
1

Member administration

option level and includes the option to select additional membership cards.

At the heart of Nexus lies the vision to provide a customer-centric solution for the full spectrum of customers served by the system. The Nexus member administration module supports this vision by managing members, beneficiaries and company details while simultaneously calculating and raising contributions. User privileges to access functions, allowing updates such as backdated changes to benefit options, are strictly controlled by the clients defined security policy. In addition, the system keeps a full audit trail of all data changes made (including user name and processed date as well as the old and new values). Late joiner penalties are automatically computed and an automatic review of the eligibility of beneficiaries may be undertaken subject to the parameters provided by the client.

1.2

Contribution raising

Nexus automatically calculates all contributions at member, family, company or branch level and has the flexibility to manage complex contribution structures such as simultaneously incorporating subsidy rules per member and/or beneficiary class. Should contributions include a savings portion, a separate savings subsidy rule could be applied to differentiate between subsidies allowed for normal versus savings contributions. Contribution tables are fully parameterised and support separate matrices per class of dependant (e.g. child or adult) or can be based on minimum and maximum values for age or calculating against income bands. Contribution raisings can be processed on either a weekly or monthly basis while contribution increases can be captured in advance. Pro-forma billing statements, actual contribution raisings and discrepancy reports are automatically generated and emailed to company branches at specified times each month to assist in the management of contribution reconciliations.

1.1

Membership cards

Nexus generates a daily, fully automated card printing function, tracking and workflow process to ensure optimal turnaround times from generation of the membership cards through to receipt by the members. Card rules may be set at client or benefit

 Uploading of membership details from different sources including online web submissions or manual capturing by a contact centre agent. Flexible, multi-level organisational and/or paypoint hierarchy which allows monthly reconciliations to be carried out at employee level. Management of backdated changes which automatically trigger the real-time re-computation of historic contributions and generation of arrear transactions which feed through to the Nexus debtors system in real-time. The ability to allow members to migrate between benefit options. A choice of automatically generated standard letters, SMSs and emails to notify members of the receipt and acceptance of new applications or other transactions including the confirmation of changes made to banking details. Automatic generation of membership cards. Support for various card printers. Management of future-dated transactions. Contribution tables are designed to accommodate age and income bands on mutiple levels and allows an unlimited number of contribution tables per product option.

Key features include:

Contribution management

This fully integrated module manages the collection, credit control and reconciliation of group and individual contributions. Group debtors are tracked and reconciled at member level while the balance outstanding (including savings portions, core contributions and late joiner fees) is accounted for at individual product level.

raised amount. Individual and group accounts may be maintained on either an open item or a balance carried forward basis. Employer group accounts are reconciled not only at branch level but also at employee/member level while statements are generated at member and/or group level. Outstanding balances are maintained at individual contributions (product) level and covers savings, core, late joiner or additional product fees.

2.1

Credit control rules

A key feature of contribution management is the rulesbased credit control function. Nexus credit control module applies a flexible set of rules to allow the automatic implementation and management of a funds credit control policy. Builtin communication triggers generate automated notifications of returned debit orders.

2.4

Individual reconciliation

Individual accounts are automatically reconciled at member level. Depending on the automated credit control rules selected, a member may be automatically suspended when the ACB payment returns unpaid.

2.5

Other credit control rules

2.2

Contribution collection

Following a similar process to that outlined above, credit control rules may also be applied to the following categories: Member Portion Rules - for example, a member owes money to the fund as a result of claims submitted and paid before notification of termination, etc. Savings Rules - for example, a member owes money to the fund as a result of terminating mid-year, but has used the full years savings balance that was allocated in advance. Combined Balance Rules - for example, a member owes a combination of amounts such as direct paying members contribution, members portion and savings.

The total monthly members contribution may be collected from employer groups or individual members either through ACB (Automated Clearing Bureau) or a manual payment. Integrated cash desk functionality is used to automatically update the reconciliation system from captured payments. Multiple bank accounts per member can also be loaded to differentiate between claim refunds, deposits and contribution deductions.

2.3

Employer group reconciliation

The debtors system is an open item system where any payment received is allocated against an open

Financial adviser administration

Nexus includes a comprehensive financial adviser module which facilitates the management and automation of key functions. This includes the automatic calculation of commission and clawbacks as determined by client fund rules and/or legislation. Transactions are generated on a real-time basis, allowing financial advisers to obtain a provisional statement at any given time of the month. Financial advisers have access to Nexus web self-service which provides a secure environment that allows online tracking of the status of queries, uploading of member application forms, updating of members details and viewing copies of monthly statements.

Generation of commission payable on a real-time basis. A facility to backdate changes to membership or financial adviser details which automatically triggers the recomputation of commissions due. Payment to financial advisers by Automated Clearing Bureau or manual Electronic Fund Transfer. Validation of eligible contribution types against rules when calculating commission (for example the core and savings portions of a contribution may be commissionable while the portion relating to a late joiner penalty may not). Management of financial adviser accreditation and VAT. Detailed reports to support financial adviser management and transaction tracking. Automated notifications when changes are made to members linked to a financial adviser. A single, consolidated, monthly statement.

Key features include:

Claims processing

4.2

Pricing engine

Integral to the design of the Nexus claims system is the concept of engines. Different, specialised engines are the driving forces that pick up claims and direct them through the various sets of rules for the particular transaction type, or to meet the criteria of a specific contract. The engines may be used in either real-time or batch submission mode. The Nexus claims engines are defined as follows:

Fund specific and generic pricing rules (relating to medicines, adopted rates of reimbursement or alternative tariffs) are applied to determine the tariff amount (including modifiers).

4.3

Assessing engine

This engine identifies the benefit and monetary limit against which the claim is to be paid and whether the healthcare provider or the member must be paid.

4.4

Clinical engine

4.1

Validation engine

A claim is checked against various parameters for validity to establish, for example, whether membership is active, treatment/chargeable code is recognised and the treatment date is not in the future.

Clinical rules applicable to the fund and benefit options are applied against third party claims management programmes/networks in line with the defined clinical rules of the various contracts. A client may define which levels of clinical rules should be applied within a particular contract and the system will then automatically process claims accordingly.

4.5

Benefits and limits engine

Central to the validation engine is a complex and comprehensive list of duplicate claim checking rules which are used to validate information within and across claims.

Once claims have been fully assessed, the final stage is to apply the amount deemed due for payment against the limits allowed and to check these against the individual member and beneficiary limits available.

Key features include:

Queries are reduced by: - Holding claims for pathology, radiology and physiotherapy to allow possible hospitalisation pre-authorisation updates. - Holding claims for newborn babies for a specified period to allow registration and avoid re-submission of claims. - Providing a report for tax accumulated claims available to all South African members. Nexus accommodates multiple chargeable/tariff structures: - Tariff schedules can be client specific, (for example NHRPL, NAMAF, NHRPL+20%, etc.) - The ability to handle provider specific contracted rates. Multiple service provider structures: - Nexus incorporates multiple provider files (i.e. BHF, Namibia Provider File, Swaziland Provider File). - The ability to produce a fund/client-specific provider file which may also be linked to a tariff structure. Multiple fund benefit structures: - Comprehensive and proven ability to handle a vast array of different benefit structures within an option, and allowing multiple provider networks with different benefit structures.

Ability to handle pro-ration of benefits at various levels as specified by the fund - for example monthly, half-yearly, per family, per beneficiary, and so on.

Easy navigation by contact centre agents: - Claims information is consolidated into a single contact centre query screen allowing intuitive and quick navigation for membership queries, healthcare provider queries, queries relating to tariffs charged, all claims queries and more. - Easy navigation to view benefit and limit usage, including claims that have been processed against the benefits being viewed. - Financial transactions indicating claims that have created members liabilities, levies charged, contributions paid and more are available at the press of a button. - During a query, a contact centre agent is able to view and explain how a pro-rated benefit has been calculated while talking to a member. Automated functions for membership updates: - Any movement of member/beneficiary dates triggers the automatic reversing of claims already paid. In the event of a member being reinstated, the claims are automatically reprocessed.

Managed care

The Nexus Managed Care modules apply a rulesbased clinical protocol process within the system. This allows users to better manage members benefits based on clinically appropriate protocols. The modules are designed in such a way that they are able to receive and adjudicate member claims internally within Nexus or external claims (interfacing with third party administration systems).

5.1

Care Templates

Specifically designed to manage out-of-hospital associated healthcare provider costs, Nexus introduces the unique ability to set up Care Templates based on customised clinical protocols for a range of diseases, such as diabetes, asthma, high blood pressure and more. Claims are offset against an allocated quantity for specified treatment groups, as opposed to a specific monetary amount per benefit. The payment of claims from a Care Template is reliant on the submission of claims containing ICD-10 (or other supported) diagnostic codes, matching chargeable tariff codes and being submitted by the agreed healthcare provider speciality as contained in the Template. 5.2 Optical risk management The optical module applies optical management rules selected by the client. Optical claims are rejected, paid or sent for manual intervention according to defined rules.

5.3

HIV Management

Nexus offers a leading HIV and Aids Disease Management module, offering clinical protocols based on the latest developments in international and local guidelines, as provided by organisations such as WHO, PENTA and the HIV Clinicians Society. This module ensures prompt payment of eligible pathology, medicine and consultation claims.

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Automated receipt and capture of pathology results from accredited laboratories; Automated electronic screening; Automated correspondence to the relevant parties.

Key features include:

5.4 Dental risk management

Designed to support appropriate quality care and to provide comprehensive up-to-date dental records, the rules-based dental management module offered by Nexus generates a tooth chart of all the teeth within the patients mouth by incorporating a tooth numbering system based on the World Dental Federation ISO3950 notation. This map is used as the basis for monitoring and providing a complete history of what takes place in the patients mouth. When a healthcare fund or insurance provider selects this module to be activated, a set of more than 5000 automated rules are applied against the patients tooth chart for each dental claim received.

claimed. If not met, an alert is generated to the healthcare provider or may lead to a rejection of the medicine(s). Some of the DUE rules are: Checks for therapeutic duplication. (Was another medicine within the same therapeutic group recently claimed for?) Is the drug claimed age appropriate? (for example, aspirin should not be claimed for young children). Checks for drug/disease interaction (for example, when blood pressure medication is prescribed for an asthmatic, it could potentially interact adversely with the asthma medication). Checks for drug/drug interaction (for example a member using a blood thinner should not claim for aspirin as well). DUE checks claims against gender (for example hormone treatment claimed by males). DUE checks the maximum daily dosage to minimise events of accidental overdosing.

5.5

Pathology risk management

The pathology management programme includes interventions which apply clinically appropriate rules to claims, apply National Pathology Group Billing guidelines. When pathology accounts fall outside of these parameters, the account will either be rejected, or in certain cases, clinical motivation will be required prior to payment.

5.6

Beneficiary risk management (including disease management)

Historical claims and clinical data are used to identify high-risk beneficiaries, handing these patients over to highly skilled registered nurses through a work-flow process, who then contact members and attempt to identify and manage the underlying issues. An example of beneficiary management would be identifying a member with diabetes who has not been claiming for chronic medication.

5.7

Nexus medicine risk management

5.7.1 Chronic medicine management

The medicine management system is a fully integrated module of the Nexus administration system which allows the pre-authorisation of medicines by a funds contracted managed care provider.

5.7.2 Clinical medicine management: Drug Utilisation Evaluation (DUE)

For all medicine claims submitted to Nexus, the principle of drug utilisation evaluation (DUE) may be applied. DUE is a set of clinical rules which are automatically applied to medicine claims on a real-time basis. The rules perform clinical evaluation of the medicines

Details of the medicine(s) authorised, including the duration of the authorisation, quantity and dosage allowed and intervals at which the medicine has been approved. Formularies (lists of medicines) covered and excluded by the client are loaded and all claims for approved medicines are then checked against these lists during processing. Out-of-formulary medicines (for example the ethical product instead of the generic equivalent) can be identified should copayments be applied to a specific category. Nexus has the functionality to trigger an SMS or email to a member on registration of a patients chronic medicine application form and approval of the medicine(s). An authorisation letter and medicine access form can automatically be generated and sent to the patient. Should a medicine not be approved, a letter is generated to both the member and the prescribing healthcare provider, stating the reasons for rejection. For South African clients, medicine claims relating to Prescribed Minimum Benefits, (PMB) are automatically recognised and will be paid, even when a member exceeds the annual allocated benefit limit.

Key features include:

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For real-time claims, the dispensing healthcare provider is made aware of any drug therapy discrepancy, based on the DUE rules, before the patient receives the medication.

5.8 Hospital Risk Management

Contractual agreements and the reimbursement/ remuneration processes for hospital claims are automated on the system. The system validates the clinical appropriateness of all hospital or hospital related chargeable codes (negotiated or standard tariff structure such as NHRPL) and ensures that healthcare providers adhere to this during the billing process.

Fee-associated rules (such as global or per event fees), which are applied to each claim line during the validation and calculation process are also supported. These include: Gender and age. Procedure or treatment rendered. Level of care of accommodation. Duration of the hospital stay. Drugs, disposables and consumables. Pre-authorisation information and criteria for approval (ICD diagnostic codes for South African clients). Benefits and exclusions with reference to fund rules, clinical policies, and hospital reimbursement guidelines.

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Key features include:

Nexus provides a consolidated view of all transactions and balances irrespective of which option a member belongs to. The module is designed to allow uninterrupted access, even during payment and month-end runs. The reasons for non-payment to members and vendors are recorded and available to system users. Various detailed reports exist to ease reconciliation and transaction tracking. One consolidated statement is sent to members at the end of each month, with a choice of being posted, emailed or downloaded from the web. Notification to members and healthcare providers via email and SMS on receipt of claims, successful processing of the claims and payment of the claims. Age analysis for members and healthcare providers which includes all financial balances. Advanced payment options with fully automated offsetting during payment runs.

Possibly most important of all, members and healthcare providers are concerned about the accurate and timely payment of claims submitted for services rendered. The Nexus financial claims payment system is a realtime, integrated, transactional system that manages the accounts and payments of members and healthcare providers. TheNexus claims payment and accounting module includes the following sub-systems:

Finance

6.2 Savings module

The savings module manages the members savings account based on the funds rules and is able to handle the full range of functions including proration, the allocation of advances and the calculation of interest on positive or negative balances.

6.3 General ledger module

The general ledger is populated with information from the financial and savings modules. Clearing accounts are created between, and within, modules to allow balancing. A general ledger query screen allows the user to query any general ledger account.

6.1 Financial module

The financial module consists of integrated Accounts Payable (AP) and Accounts Receivable (AR) functionality that allows real-time interaction based on a funds rules. All transactions related to a healthcare provider or member can be viewed on a single screen allowing the user to drill down to the finest level of detail.

6.4 Workflow module

The workflow module is a generic module which is used to approve transactions that have a financial impact. The module allows an approval hierarchy structure to be established and maintained within the credit control business area.

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A product is only as good as the service it provides and Nexus has gone to great lengths to ensure that the Nexus On Call (NOC) module is a comprehensive, user-friendly contact centre solution which minimises conversation time and maximises first-time query resolution. NOC is used to log, track and finalise queries from members, beneficiaries, healthcare providers, financial advisers and employer group representatives. Nexus On Calls unique beneficiary call logging ability allows contact centre agents to capture incoming queries on beneficiary level. This feature ensures comprehensive reporting, providing funds with specific information relating to: Number and types of queries received for principal members. Number and types of queries received for different beneficiaries with the same membership number. Number and types of communication sent to members during any given period. Often, a single healthcare provider will phone a contact centre to query multiple members and beneficiaries. Similarly, a member may phone on behalf of a beneficiary. Nexus On Call provides a holistic solution ensuring that information is correctly captured and that the relevant information and query responses are directed to the right people.

Nexus On Call (NOC)

This unique capability reduces time spent on calls and increases first-time query resolution. All correspondence received (e.g. scanned claims images) or sent (e.g. confirmation of benefits) is indexed against the specific beneficiary for which a query was generated.

7.1 NOC: Beneficiary call logging

Through NOC, each contact centre is able to create various workgroups dedicated to specific query types (for example dedicated contact centre agents could deal exclusively with claims reconciliation queries) which are linked to minimum turnaround times or service level agreements. Nexus can be interfaced to various workforce optimisation products in the contact centre including *CTI (Computer Telephony Integration) and **IVR (Interactive Voice Response).
*CTI (Computer Telephony Integration) This useful tool allows contact centre agents to identify callers as soon as a call is received. The caller (member, healthcare provider, financial adviser or employer group representative) enters specified details before being transferred to a contact centre agent. The callers details are displayed on the agents screen at the press of a button when he or she receives the call. This feature allows the agent to greet the caller by name and provides a history of any recent activity at a glance.

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**IVR (Interactive Voice Response) IVR is designed with improving customer service in mind. It works 24 hours a day seven days a week. The IVR is an automated system that allows both member and healthcare provider to complete queries without human intervention. Queries that can be dealt with through IVR include benefit confirmations, requesting membership certificates, application forms, chronic medicine application forms and more. This, in turn, reduces contact centre queue times.

A full call and query history is available at the time of logging a call. Multiple queries can be logged with a single incoming call (e.g. a healthcare provider querying multiple members). All supporting documentation is stored in the database and attached to the query for easy reference.

NOC includes a vast array of reports, ranging from contact centre efficiency and workgroup reports to query types, resolution times, query medium used (contact centre, IVR, faxes, emails, etc.) to allow effective management of staff, identifying potential issues and managing member expectations.

7.3 Call resolution

Once a query is logged, the user is able to access a range of data screens within Nexus to assist with query resolution. The query may be work-flowed to a specialist for resolution if it cannot be resolved at the time of contact with the member. Any call not resolved within time limits, as set out by each fund, is automatically escalated through a hierarchy within the contact centre organisation. Members are automatically notified via SMS or email once the call has been resolved.

7.2 Logging queries on NOC

In addition to telephonic or walk-in queries, Nexus On Call directly interfaces with email and fax for receiving and capturing queries. Queries can be logged at member or beneficiary level, allowing detailed trend reporting.

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8.

Automated communications

Integral to Nexus is a comprehensive, integrated rulesbased, real-time communication system which can be branded to the unique requirements of a fund. The fund decides how, when, how often, what and with whom communication will take place. This optimises the flow of information to members, healthcare providers, employer groups and financial advisers. Different communication items are set up to be sent in different ways and includes sms, email, post and fax. Messages can be set up for different recipients eg. members, providers, trustees, healthcare providers, financial advisers etc. Nexus communication module includes over 80 types of automated communication triggers, generating messages for members, healthcare providers and financial advisers. Examples of automated Communications are: Benefits reached Chronic authorisations Contact details updated Option change Birthday greetings Claim acknowledgement Member statement Tax certificates

All outgoing and incoming correspondence between the recipient and the fund is stored on the system and attached to the relevant recipients query and call reference number. Optimal communication decreases the need to phone the contact centres and promotes a better understanding of the fund rules, benefits and processes while instilling business confidence in all parties interacting with the clients fund or administrator.

Interesting Facts:

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Over 22 million emails were sent from Nexus in 2009 97 million sms were sent from Nexus in 2009

Imaging and third-party integration

9.2 State-of-the-art switching
Electronic Data Interchange (EDI) on Nexus refers to the structured transmission of data between organisations by electronic means.

9.1 Nexus scanning and imaging

For most corporate companies striving to achieve a paperless environment, and particularly for healthcare fund and insurance administrators who are in the business of processing large volumes of paper, scaning, interfacing and imaging plays a vital role.

9.2.1 Real-time claims submission

This functionality enables an electronic data interchange (EDI) company to populate claims information directly into Nexus which eliminates the need for paper claim submissions.

Automatic uploading of all scanned documentation such as paper claims, membership applications and correspondence. These scanned documents are retrievable and can be viewed on a real-time basis by contact centre agents, assessing and back-office staff. Electronic images are stored and can be tracked using a sophisticated indexing system. An intelligent barcode identifier is used to direct the image to the appropriate Nexus processing module. This enables Nexus to provide much needed statistical data covering the quality and quantity of scanned documents over a selected period per fund and per scanner. Ongoing enhancements to the scanner hardware and software. The processing modules and business processes ensure that Nexus is continuously upgraded and improved to deliver exceptional service levels to customers.

Key features include:

9.2.2 Web services data submission

This functionality enables a third party to submit data (for example authorisations for hospital admissions or chronic medicine as well as claims data) through the web services interface. The advantage of using this approach is that web services achieve a significantly faster transfer rate resulting in improved turnaround times as well as greater overall efficiency for business-to-business transactions.

9.2.3 Batch claims submissions

Should a client not have enabled technology to interact with Nexus as described above, the system also offers a batch submission option.

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Reports

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In a world where data mining and access to information is key to making informed business management decisions and to manage performance, costs and risks, Nexus boasts a host of standard reports available to users at their fingertips. Nexus gives the option to allow reports to be run on a real-time basis or to be scheduled to be run at specific times. Reports can be viewed graphically or exported to a variety of formats including exports into Adobes PDF, Rich text formats, CSV files and Microsoft Excel. Reports are parameterised, giving the user the freedom to extract very specific information.

Key features include:

Access to reports are governed by user profile and administrator rights. Different administrators can only view information relating to their own group of clients through the application of Oracles Virtual Private Database (VPD) technology. Scheduling tool available to the users to manage report generation at specific times.

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Security & access control

With the increasing availability of tools with which databases can be accessed, as well as the increasing sophistication and skills of users, the matter of data protection is of high priority. International audit standards are becoming stricter while data and users proliferate. The balance of restricting access to data while not restricting a users ability to perform their job efficiently and effectively, is a delicate one. Nexus addresses both aspects by having a multi-tiered security access control system with a wide reaching audit system where access, once allowed, is recorded as outlined below.

Key features include:

System security is controlled at various levels, each of which builds on the one before to provide a multi-layered access control system.

Different administrators and/or funds can only view information relating to their own group of clients through the application of Oracles Virtual Private Database technology, regardless of where Nexus is hosted. Linked to profiles are user roles or work functions such as the ability to generate membership cards, perform credit control functions, and query contributions. Profiles all have start and enddates and are subject to stringent application and control processes. Within the database, each user is limited to the minimum level of access needed to fulfill his or her work function. Access to the database itself is further protected by the use of password encryption, which ensures that a person who manages to learn a username and password combination in the system cannot use that same password to access the database directly.

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Self-service & web access

Useful static information such as publications, relevant news, electronic forms and claiming guidelines are also available within this zone.

A primary feature of the Nexus system is its userfriendly, self-help functionality which allows users 24hour interface with the system. Accessed via a secure username and password, this web-based facility allows users to view real-time information, update details and monitor transactions within a custom branded environment. Nexus web functionality covers five user zones:

12.3 Financial Advisers zone

Access to commission payment information which may be viewed at various levels and exported onto the intermediarys system is the primary function within this zone. This functionality is supported by the ability to generate a range of value-added reports and statements and rapid access to relevant information including member details, financial adviser codes as well as details of employer group/branch/paypoints.

12.1 Member zone

The member zone is designed to facilitate rapid access to relevant information. In addition, members are able to update personal details, apply online, pre-authorisations, conduct benefit enquiries, obtain authorisation enquiries and track progress of claims submissions and payments. A useful audit trail feature also allows members to track membership changes that have been made.

12.4 Trustee zone

Designed to be used as a document storage facility, this secure zone allows personalised access to fund specific information and documentation.

12.2 Healthcare provider zone

Specifically designed with the needs of healthcare professionals in mind, the healthcare professional zone allows healthcare practices to access contact and banking details and personalise correspondence options according to preference. Rapid access to information regarding patients benefits and limits, claim and remittances, chronic medication and authorisations, as well as look up functionality for diagnostic codes, NAPPI codes and chargeable tariffs is also provided.

12.5 Employer zone

Introduced as a value added service to employers, the employer zone allows employers to update relevant employee information, download applicable registrations forms electronically and access relevant information to assist with the resolution of staff queries. Aligned with the Nexus philosophy of continuous improvement and development, new functionality is continuously designed to add value to Nexus range of user groups.

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Conclusion
Nexus is arguably one of the largest online, real-time enabled healthcare transactional systems in the world. Nexus consists of close to four million lines of programming, supported by a dedicated team of developers, product support staff and business analysts as well as a team of database administrators who keep all systems running. Nexus continues to incorporate the latest proven technology to ensure that clients benefit from greater efficiencies and market-leading service delivery. Underpinned by stringent security and independently audited controls, Nexus sets the standard against which industry administration systems are measured.

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