theclaimsXchange User Guide

VERSION. 1.1
 TABLE OF CONTENTS

1.0 Introduction ______________________________________________________________________ 3

2.0 Provider Office/Clinic Registration ___________________________________________________ 4
1.1.1 Registration confirmation _______________________________________________________________ 7
3.0 Practitioner Enrollment _____________________________________________________________ 8
3.1 Add a New Practitioner ___________________________________________________________________ 8
3.2 Edit a Practitioner ______________________________________________________________________ 14
3.3 Delete a Practitioner ____________________________________________________________________ 14
4.0 Provider Office/Clinic Review or Update ______________________________________________ 15
5.0 Banking _________________________________________________________________________ 16
5.1 Add Banking Information __________________________________________________________________ 16
5.2 Modify Banking Information ________________________________________________________________ 17
6.0 Password _______________________________________________________________________ 18
6.1 Modify Password or Security Question _______________________________________________________ 18
7.0 Claims _________________________________________________________________________ 20
7.1 Select a Patient __________________________________________________________________________ 20
7.2 Edit a Patient ____________________________________________________________________________ 21
7.3 Delete a Patient __________________________________________________________________________ 22
7.4 Add a New Patient ________________________________________________________________________ 23
7.5 Submit a Claim ___________________________________________________________________________ 25
7.6 Certification and Authorization _____________________________________________________________ 29
7.7 Claim Confirmation _______________________________________________________________________ 30
8.0 Payments _______________________________________________________________________ 34
8.1 Payment Details ________________________________________________________________________ 34
9.0 Links to Assist you ________________________________________________________________ 36
9.1 User Guide ______________________________________________________________________________ 36
9.2 English/Francais __________________________________________________________________________ 36
9.4 Logout _________________________________________________________________________________ 36
9.5 Terms and Conditions _____________________________________________________________________ 36
9.6 Legal Information ________________________________________________________________________ 36
9.7 Contact Us ______________________________________________________________________________ 36
10. Glossary ________________________________________________________________________ 37

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1.0 Introduction
TheclaimsXchange is a proprietary web portal designed by NexgenRx to allow Health
Care Providers to register their office/clinic and submit claims in real-time on behalf of
eligible plan members and their dependents. The Portal has been upgraded from the
original version, so you will notice a different “look and feel”.
In addition, the Registration and the Enrolment of Practitioners (health care
professionals) have been simplified, eliminating some redundant steps which will allow
you to register and submit claims as quickly as possible.
This is the first of two phases of changes so look out for additional features in the next
phase.

If you have any trouble with the site, please try clearing your computer or laptop cache
by going to your browser Settings/Privacy/Clear browsing data/Choose what to clear
and select to clear Cached Images and Files.

Note: theclaimsXchange works better with Microsoft Edge and Google Chrome.

You can access theclaimsXchange from either of these two points:

• Go to the NexgenRx website at: [Link] and select theclaimsXchange link or
• Enter the following URL in your browser: [Link]

• For a new registration, please select the Register here hyperlink, which will launch the
Registration Page.
• For existing registrations, enter your email and password
• If you have forgotten your password, select the Forgot Password hyperlink

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2.0 Provider Office/Clinic Registration
In order to register your clinic/office successfully, you must use an email address that
has not been used before for theclaimsXchange, as the email address is used as part of
the credentials for accessing theclaimsXchange.

Once you have selected the Register Here hyperlink from the main page, the
registration page will be launched for you to complete the information required by
theclaimsXchange. Please enter the information as shown below and note that all fields
marked with a red asterisk are mandatory.

You can define your own password and a security question with your answer, which will
be asked and must be answered correctly, if you choose the ‘forgot password’ feature
in the future. Please remember to keep this information safe.

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Once you have entered all the mandatory information the following pop-up message will
be displayed indicating the registration is successful and you will be re-directed to the
login page.

TheclaimsXchange login page is launched for you to enter your email address and
password you defined in the registration.

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1.1.1 Registration confirmation
An email will also be sent to the email address you entered during the registration process,
with your unique theclaimsXchange Office Id assigned to your Provider Clinic/Office.
You can use this id if you need to communicate with theclaimsXchange team at any time.

Once you have logged in, you will be presented with the following landing page, where
you can now select to enroll the Practitioners (health care professionals) who work within
your office/clinic.

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3.0 Practitioner Enrollment
Please select the Practitioners tab to enroll all of your Practitioners working out of your
office/clinic. Once selected, your options are:

• Add a New Practitioner to the office/clinic.

• Edit an existing Practitioner’s first and last name or
• Delete an existing Practitioner from the office/clinic

Note: It is very important that once changes are made to this screen you must select the
Save All Changes button in order to save any additions, modifications or deletions,
otherwise the changes will not be saved to your office/clinic profile.

3.1 Add a New Practitioner

To add a new practitioner, select the New Practitioner button.

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The following sub screen is displayed with notes to assist with adding Practitioners.

New Practitioner Search: This feature provides the option to Search for the Practitioner by
entering the Practitioner’s Licensing Province, Practitioner Service Type and Practitioner
License Number.
• The Practitioner’s Licensing Province, Service Type and License #. are all mandatory fields for
conducting a search.
• If the Practitioner is already in NexgenRx’s database with an Active status the Practitioner
details will be displayed for verification by the user before saving to the grid and will be
approved once the Save All Changes button is selected.
• If the Practitioner is retrieved with more than one License Issuer/Governing Body/College,
then this field will be enabled to allow the selection of the correct License Issuer/Governing
Body/College applicable to your Practitioner.
• If the Practitioner cannot be retrieved using the search parameters, you will be prompted to
add the Practitioner’s details in the fields below. Once the Add (add to the grid) and Save All
Changes button are selected, the ClaimsXchange team will be notified, and will perform a
manual validation of the Practitioner(s). The Practitioner’s status will show “waiting for
Approval’.
• Once the Practitioner is approved, an email will be sent to advise you of the status, and the
Practitioner’s status will be updated within your Portal.

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Search for a Practitioner by entering the following in the New Practitioner Search frame.
All fields are mandatory for this search.
• Practitioner’s License Province
• Practitioner’s Service Type
• Practitioner’s License #

Select the Search button to search for the Practitioner or

Select Cancel to cancel the search

The Practitioner details will be displayed below the Search fields.

Select the Radio button to confirm selection

Verify the Practitioner Details
• If the License Issuer field is blank, please select the appropriate value from the drop box

Select the Add button to add the Practitioner to the grid or

Select the Cancel button to cancel the search
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If the Practitioner is already in theclaimsXchange database with an Active status, the Practitioner
will be approved immediately with a status of Active.

Select OK
Select the Save all Changes button
The Practitioner has now been successfully added to the Office /Clinic with an Active status.

Note: If an error was made, you can select the Discard All Changes button to ignore all
changes.

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If the Practitioner cannot be found within the theclaimsXchange database, you will be prompted
to add the Practitioner details in the Practitioner Details frame.

Enter the Practitioner Details

Please note that all fields are mandatory when adding the Practitioner Details. Enter the
following:
• Practitioner’s First Name
• Practitioner’s Last Name
• Practitioner’s License #
• Practitioner’s (License) Province
• Practitioner’s Service Type
• License Issuer/Governing Body/College

Select the Add button to add the Practitioner to the grid.

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The Practitioner will be added to the grid with a status of New Record.

Select the OK button to confirm verification.

Select the OK button to continue.

Select the Save all Changes button to save all changes made.
Select the OK button to confirm all changes made for Practitioners.

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3.2 Edit a Practitioner
To edit a Practitioner, select the Radio button to the left of the Practitioner record
displayed in the grid and select the Edit Practitioner button.
Here you can edit the Practitioner’s first and last name only.
Select the Update button to update the Practitioner’s record
Select the Cancel button to cancel the update

3.3 Delete a Practitioner

To delete a Practitioner, select the Radio button to the left of the Practitioner record
displayed in the grid and select the Delete Practitioner button.
You will be asked to confirm the deletion.
Select the OK button to confirm the deletion of the Practitioner from your office/clinic

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4.0 Provider Office/Clinic Review or Update
You can review and update any of your information provided during the Registration of
your Office/Clinic.

To review or modify this information, please select the Provider tab and modify any of the
fields displayed. You can also change the email address, if necessary, but remember this is
the email address that is used for accessing the Portal.

Select the Submit button to submit the changes and select the OK confirmation button.

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5.0 Banking
In order for claim payments to be assigned to the office/clinic, banking details must be
provided for direct deposit.
All fields on this page are mandatory when adding for the first time, but the banking
details can be modified at any time.
Payments will be made to the bank account that was in effect at the time the claim
payment was issued as theclaimsXchange maintains a history of bank account changes.

5.1 Add Banking Information

To add your Banking Information, please select the Banking button and add all of the
following:
• Bank Name
• Bank Transit Number
• Bank Number
• Account Number

Select the Submit button to submit the changes or

Select the Cancel button to cancel the changes

Select the OK button to continue.

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5.2 Modify Banking Information
To modify the Banking information, please select the Banking button and modify the
necessary information.
Select the Submit button to submit the changes or
Select the Cancel button to cancel the changes

As a security measure, once the banking details are entered for the first time or are
modified, an email confirmation will be sent to the email address provided.

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6.0 Password
You may review or modify your password and/or the security question created during the
Registration, at any time. In order to make changes to this screen, your existing password
must be provided.

6.1 Modify Password or Security Question

To modify the password or security question please select the Password button.
Your email address will be displayed and protected and cannot be changed on this page.
You can change your email address by using the Provider tab.

To modify only the Password

• Enter your current password
• Select the Reset Password checkbox
• Enter your new password
• Confirm your new password

To modify only the Security Question.

• Enter your current password
• Select Reset Security Question checkbox
• Enter your Security Question
• Enter your Security Answer
• Confirm your security answer

To modify both at the same time select both checkboxes.

Select the Submit button to submit the changes or
Select the Cancel button to cancel the changes

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Select the OK button to continue.

As a security measure, once the password or Security Question has been re-set, an email
confirmation will be sent to the email address provided.

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7.0 Claims
Claims can be submitted for patients of the clinic and payments can be assigned to the
Member or to the Office/Clinic.

If payments are being assigned to the Provider Office, then it is mandatory to have the
banking details added for direct deposit of payments.

Please select the Claims button to launch the Claims Page.

7.1 Select a Patient

If the patient is an existing patient within your Office/Clinic, you can search for the patient
listed within the grid by:
• First Name and/or
• Last Name and/or
• Postal Code

You can also click on the column hyperlink to sort patients in ascending or descending
order based on the column hyperlink you select.

Select the Reset button to reset the search fields to the default values.
Note: You can select the hyperlinks to sort the displays within the grid in ascending or
descending order.
Once the patient is found, select the radio button to the left of the patient’s name

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7.2 Edit a Patient
Patient information can be modified but their details must match the data registered
within the theclaimsXchange database. This is usually the data provided on the patient’s
health card.

To edit the patient information, find the patient in the grid and select the radio button to
the left of the patient’s name.

• Select the Edit Patient button

• Modify the required details

Select the Save button to save the changes

Changes will be displayed within the Patient grid.

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7.3 Delete a Patient
Patient information can be deleted from the Office/Clinic, if necessary.

To delete the patient information, find the patient in the grid.

• Select the radio button to the left of the patient’s name.
• Select the Delete Patient button
• Select the OK button to confirm the deletion

The patient will be deleted from the grid.

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7.4 Add a New Patient
New patients can be added at any time, and it is recommended to add this information
from the patient’s Insurance health card, to ensure it matches the data registered within
the ClaimsXchange database.

To add a new patient, select the Add New Patient button.

Add or select the following:

• Carrier Id: Select the Carrier Id from the drop box (NexgenRx or the co-operators)
• Group Number: The Group or Policy Number the member is registered under
• First Name: First Name of the patient
• Last Name: Last Name of the patient
• Relationship: The relationship of the patient to the insured member
o Primary: Member
o Spouse: Spouse of the member
o Child: Child of the member
• Patient Code: The code assigned to the member or patient as listed on the Insurance health card

Select the Save button to add the patient to the patient grid.

The Patient is added to the grid, and you can now submit claims for the patient.

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If you receive an error while adding a new patient, please double check the data entered. If
the error persists, it is quite possible it does not match the ClaimsXchange data.

You may contact the ClaimsXchange team for assistance by calling 1-866-394-3648 or by
sending an email to help@[Link]

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7.5 Submit a Claim
In order to submit a claim, you must first select a patient from your patient list.
Note: You can select the hyperlinks to sort the displays within the grid in ascending or
descending order.

• Choose the patient from the grid by selecting the radio button to the left of the patient’s name.
• Select Yes or No if the patient has other coverage under another plan?
o If yes is selected, you will need to indicate the amount received for this claim from the
other insurer, when adding the service amount.
• Select the NEXT button to continue or
• Select the Main Menu button to cancel and return to the Main Menu

• Review the On-Line Claim Submission Service Responsibilities and select the Agree checkbox
• Select the Practitioner from your Practitioner list.
o If you have multiple Practitioner Types working in your office/clinic, you can limit the
display by selecting the appropriate Practitioner Type from the Practitioner Type drop box
• Select to whom the claim payment must be made to: Member or Office/Clinic
o Note NexgenRx does not pay the individual Practitioners. Payments are made to the
Office/Clinic
• Select the NEXT button to continue or
• Select the Previous button to return to the previous screen or
• Select the Main Menu button to cancel the claim and return to the Main Menu

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• Select the Add Expense to add the service and service charges

• Add the Expense details in the Popup screen

• Service Date: This date must be on or after the date the Practitioner was associated with
the Office/Clinic
• Type of Expense: Select the service provided in the drop box.
o Only services the patient is covered for will be displayed in the Type of Expense
drop box
• Total Receipt Amount: Amount for the service provided
o If you had indicated earlier that the patient has other insurance, a field to add the
amount paid by the other insurer will have to be completed
Select SAVE to save the expense to the grid or
Select Cancel to cancel adding the expense

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 • You may add multiple expenses to the claim by repeating the steps above.
• You can Indicate whether a physician referral letter was received or not
o If a referral letter was received add the following
o Date of Referral
o Referral Type (MD or other)
o Referral Practitioner Name
• You must indicate if the service is being submitted as a result of a motor vehicle accident
o There are groups with certain rules requiring this information. If it is not applicable to your
patient, this question will not be displayed.
• If the patient has a Health Care Spending Account a question will be displayed for you to confirm if
any balances from the claim should be paid under their HCSA account.
o Please receive approval from the patient before answering this question.

Select Next to proceed to the next page

Select Previous to go back and make corrections
Select Main Menu to cancel the claim and return to the Main Menu

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7.6 Certification and Authorization
Please review and agree to the terms within the Certification and Authorization page.

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7.7 Claim Confirmation
The claim confirmation page will display the following details:

• Status of the claim

• Patient Name: Member or dependent
• Policy: The number assigned to the group the member is covered under
• Certificate: The number assigned to the member
• Provider Code: The unique claimsXchange number assigned to the office/clinic submitting the
claim
• Provider Name: The name and address of the office/clinic
• Practitioner: The health care professional who performed the service
• Pay To: The recipient of the payment (Member or Provider)
--------------------------------------------------------------------------------------------------------------------------
• Online claim reference number: The unique # assigned by theclaimsXchange for this claim
o Please use this number as a reference if contacting the theclaimsXchange team
• Amount submitted for your claim: The total amount submitted on this claim
• Amount paid for your claim: The total amount paid on this claim
• Amount paid from HCSA: The total amount paid from a patient’s Health Care Plan
o please ensure you ask the patient first before selecting Yes to pay balances from the
patient’s Health Care Spending Account
• If the payment is to be made to the provider, a notification that payments will be deposited to the
Provider’s bank account within 2-5 business days of the payment cycle which is the 1st and 16th of
the month.
• An email notification will be sent as a reminder when the Explanation of Benefits (EOB) is available
online under the Payment page
• Description of service: Description of the service provided to the patient
• Service Date: Date the service was performed
• Submitted Amount: Amount charged for the service
• Coinsurance %: The percentage of the eligible amount the insurer pays
• Coinsurance Amount: The coinsurance dollar value of the eligible amount the insurer pays
• COB previously paid: An amount paid by another insurer for this claim
o This would be valued if during the claim submission, you selected Yes to whether the
patient had other coverage under any other plan, and you entered the amount the other
insurer(s) reimbursed when adding the expense to the claim
• Paid HCSA Amount: The amount paid from the patient’s Health Care Spending Account for this
claim
o This would be valued if during claim adjudication, you selected Yes to whether the patient
wanted any unpaid balances to be paid from their HCSA Account
• Paid HCSA Amount including HCSA if applicable: The total amount paid from both the patient’s
traditional health plan and their health Care spending Account
• Status: Status of each of the expenses submitted e.g., Approved or Rejected
• Reason Code: The reason the claim was rejected or reduced. You can click on the hyperlink to view
full descriptions of reasons the claim the rejected or reduced.

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 o If the total submitted amount was approved for payment, there will be no reason codes
displayed
• From the claim confirmation, your options are:
o Print a copy of the confirmation: This is recommended so that you can reconcile your
claims and payments when the payments are issued on the 1st and 16th of each month.
o Return to the main menu: This will take you to the main menu of theClaimsXchange Portal
o Submit another claim: This will take you to the page to select another patient to submit
another claim
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7.8 Print or Save the confirmation
• You can select the Print button on the Claims Confirmation page to print or save a copy of this
confirmation for your files and the assist with payment reconciliation.
Select Print to send a copy to your printer
• Select Close to close the screen
• Right- mouse click and select Save as to save the confirmation page to your local drive.

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8.0 Payments
You can check for Payments that have been assigned to you by selecting the Payments
tab. Payments are deposited to your bank account within 2 – 5 business days of the
Payment cycle which is the 1st and the 16th of each calendar month.

The following fields are displayed on the Payments page

• Payment Date: The date the payment was made
• Payment Amount: The amount for all claims submitted within the payment cycle
• Payment Number: The number assigned to the EFT payment
• The ability to view payment details or entre payment
• Carrier: the carrier responsible for the payment of the claim (NexgenRx or the Cooperators).

Note: You can select the hyperlinks to sort the displays within the grid in ascending or
descending order.

8.1 Payment Details

The Payment details allow you to view payments for each claim or, the entire payment for
all claims within the payment cycle.

Select the Payment Details button to view the claims for each payment on one statement.
Select the Entire Payment button to see all of the claims for each payment on one
statement.
You can right mouse click and save the statements to your local drive.

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If you select to view the Payment Details, the following sub screen will be displayed to
show all the claims for the payment
Select the download button to view the detailed payment information for the claim
selected.

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9.0 Links to Assist you
Each page provides the following links which are described below. At the top of each page,
you can find the following links.

9.1 User Guide

You can select this link to launch theclaimsXchange User Guide in a pdf format.
This document explains how to use the Portal.

9.2 English/Francais
You can select this link to switch from English to French or, from French to English. All
screens and messages will be displayed in the appropriate language.

9.4 Logout
Select this link to log out of the theclaimsXchange Portal correctly and safely.

At the bottom of each page, you can find the following links.

9.5 Terms and Conditions

Select this link to review the Terms and Conditions and the Privacy Statement.

9.6 Legal Information

Select this link to review the Legal Information including copyright and Trademark

9.7 Contact Us
Select this link to review how to Contact Us

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10. Glossary
Term Description
theclaimsXchange theclaimsXchange® is a web portal for healthcare providers who
submit claims on behalf of eligible plan members and their
dependents. This portal provides access for health care providers
to register and submit claims for immediate adjudication.
Provider An office/clinic/health care facility providing services to patients
Practitioner The health care professional who works at the office/clinic/health
care facility and is providing the actual service.
License Issuer The License Issuer, Governing Body or College where the
(Governing Practitioner renews their practicing license.
Body/College)
Office code/id The unique id assigned by theclaimsXchange to each registered
Provider office/clinic
Carrier The Insurer responsible for adjudicating the claim for the
group/policy
Group/Policy A unique number within a Carrier that is assigned to the
Number company the member is insured under
Member/Insured The person who is insured under the group/policy
Certificate The unique number within a group/policy that is assigned to the
member/insured
Patient The dependent (or member) who is covered under the member’s
insurance e.g., the spouse or child.
HCSA Health Care Spending Account. This is an additional plan with
specific dollar limits, the member has, in addition to their
traditional insured plan. The member can choose to use this plan
to pay any balances not covered by the traditional plan limits.
Coinsurance % The portion of the claim the Insurer is responsible for, defined as
a percentage
Coinsurance Amt. The portion of the claim that insurer is responsible for, defined as
a dollar value
COB Coordination of Benefits. When a patient is insured under one or
more plans and claims can be coordinated with the other
insurer(s).
Note: patients cannot receive more than 100% of the cost of a
service.
EFT Electronic Funds Transfer of payment

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