Medical Claim Billing

Don't lose money on your medical claims

IMPROVE MEDICAL BENEFIT MANAGEMENT

When it comes to providing immunizations, clinical services, DME and specialty drugs to patients, are you sure you’re receiving appropriate reimbursement? As pharmacies become more involved in clinical care, it’s more important than ever to ensure that you’re properly reimbursed for the growing number of items covered under the medical benefit.

CareCLAIM® is the pharmacy industry’s leading medical claim billing solution, trusted by over 30,000 pharmacies across the country to optimize reimbursement on medical claims. CareCLAIM enables you to bill for items covered under the medical benefit and optimize reimbursement for the immunizations, clinical services, DME and specialty drugs you provide to patients.

COVID-19 VACCINES: STREAMLINE YOUR WORKFLOW & GET REIMBURSED

OmniSYS has the resources you need to support the administration and reimbursement of the COVID-19 vaccine at your pharmacy.

Let OmniSYS take the guesswork out of COVID-19 vaccination administration for you, and eliminate manual, time-consuming processes.

DENIALS HAPPEN. BUT THEY DON'T HAVE TO.

40M

transactions processed each year

$150M

saved per year by reducing bad debt

99%

collection rate

2–4%

increase in profits with denial tracking

Medical claims made simple

CareCLAIM allows you to submit claims for professional services, immunizations, durable medical equipment (DME), medical supplies and drugs covered under the medical benefit just as you would any other third-party prescription insurance. We manage the entire medical claims process for you, from claim submission to remittance to denial management and audit support.

Rev up your revenue cycle

We are the industry leader in medical claims processing, with collection rates of up to 99 percent. With over 550 proprietary messaging edits and the ability to proactively identify immunization opportunities, CareCLAIM ensures payer-compliant claims and optimizes your reimbursement. We provide daily reimbursement tracking and robust analytics reporting to improve your cash flow, and proactively resolve denials and audits to save you both time and money.

Don’t leave money on the table

When it comes to providing immunizations, clinical services, supplies and drugs to patients, many pharmacies are leaving money on the table. CareCLAIM has the unique ability to translate pharmacy transactions into medical claims, ensuring proper reimbursement of all items covered under the medical benefit. We support over 30 therapeutic classes and most pharmacy-provided clinical services, including:

Immunizations
Birth control consulting
Biometric screening
Medical nutrition therapy (MNT)
Diabetes self-management training (DSMT)
Diagnostic testing (including flu, strep, UTI)
Durable medical equipment (DME)
Oral anti-cancer, immunosuppressive and respiratory drugs

Hear from a successful pharmacy

"OmniSYS improved my denial collection rate from 38% to 98%. I trust OmniSYS with our revenue cycle business. They always deliver excellent customer service and support. Their Medicare Part B expertise is critical in addressing our questions and providing feedback to our pharmacists. I truly appreciate the knowledge and assistance they bring to us!"

David Mitchell

Pharmacy Manager, Academic Medical Center, Northern California

The CareCLAIM Difference

Connected to Medicare, Medicaid and hundreds of commercial payers
Proven, scalable solution
Real-time eligibility for all payers
Medical claim submission
835 remittance and AR management
Denial recovery and audit services
Document collection, review and repository services
Pre-dispensing medical necessity document collection
Explanation of benefits (EOB) posting
Complete claim analytics and reporting
Exceptional customer service

Let's start growing your pharmacy with CareCLAIM

Tell us a little about your pharmacy business so that we can match you with the right technology expert for your needs.