Medical Claim Billing

Don't lose money on your medical claims

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 25,000 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. 

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

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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.

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Prescription medicine on dollars for pharmaceutical industry concept of high cost for healthcare and medication

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
"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!"
UC_Davis_Health_logo
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
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Let's Start Growing Your Pharmacy with CareCLAIM

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