END-TO-END CORE ADMINISTRATION

A configurable, rules-driven solution with demonstrated capability, flexibility and reliability.

The QNXT Enterprise Core Administration System is a configurable, rules-driven, end-to-end core administration solution with demonstrated scalability, flexibility and reliability. It supports multiple lines of business on a single core platform, including Commercial, Individual, Medicare, Medicaid, Duals, Consumer-Directed Health and Specialty. QNXT’s vast array of functions and full solution suite of modules include everything a payer organization needs to manage their data and operations, including:

• Medical and Specialty claims processing
• Claims re-pricing
• Capitation/risk fund management
• Premium billing
• Provider network management
• Group/membership administration
• Referral management
• Hospital and medical pre-authorization
• Case management
• Customer service
• Electronic data interchange

The out-of-the-box solution has deep rule-based features and functions that promote automation and accuracy. Built on an open platform with service-oriented architecture, the QNXT application delivers the flexibility and functionality necessary to improve performance and increase efficiency. It also helps you compete more effectively in the ever-changing healthcare market and positioning your organization to minimize financial risk and comply.

Unlike many other systems, QNXT treats each individual insured member as one unique entity, even if that member’s eligibility fluctuates and changes over time. This allows healthcare organizations to easily understand the overall historical experience of individual members, no matter how often their eligibility changes. An individual member's record holds all the data and therefore everything stays together when viewing a member’s lifetime experience.