Claims Processing


Accelerate Reimbursements and Reduce Complexities with OmniSYS’ Medicare, Medicaid & Commercial Claims Processing Services

Medicare Part B

OmniSYS offers claims processing solutions that provide the ability to submit claims for DME/HME items, supplies and drugs, just as you would with any other third-party prescription insurance.

Our proprietary systems have over 500 customizable edits to ensure compliance with Medicare and provide real-time responses at the point-of-sale to eliminate unnecessary claim rejections. Fees, coinsurance and patient deductibles are tracked and calculated along with the claim assignment and coverage, ensuring the correct co-pay is collected from your patient.

Enrollment in OmniSYS’ Medicare Part B Claims Processing solutions delivers the highest level of customer service through prompt claim reimbursement and comprehensive compliance services, leading to improved prescription volume and increased revenue.

A customer who recently moved from a competitor to OmniSYS benefitted from a 4% increase in collection rate, preventing millions in bad debt.

12 Month Medicare Collection Rate

             Competitor: 95.11%              OmniSYS: 98.74%

Medicare Part B and Commercial Immunizations

Immunization billing and administration can be complex and may vary from state to state and payer to payer. Currently, Medicare Part B pays 100 percent of the allowed charge, without deductibles or co-pays. Reimbursement rates for covered vaccines are set nationally each year, however, allowable administration fees vary by locality. From a commercial insurance perspective, pharmacies may have contracted rates and copays may vary by plan. For most commercial plans, vaccines are considered preventative care and co-pays are not applicable.

OmniSYS supports commercial immunization billing for flu, pneumonia, as well as multiple other types of vaccines that vary based on payer coverage when administered in a DME setting. OmniSYS returns contractual pricing on the point of sale response as well as confirms eligibility when available. All claim level data is accessible via our internet portal allowing your team to effectively manage your receivables.

Medicaid and Commercial

OmniSYS provides claims processing services for Medicaid Primary, Medicaid Secondary Coordination of Benefits (COB) and Commercial Insurance Claims. Our integrated services allow you to submit claims electronically for DME/HME items, supplies and drugs, just as you would with any other third-party prescription.

Our edits reduce your risk of delayed payment due to coverage issues not addressed at the point-of-sale. Our system reduces paperwork and eliminates the need for costly DME processing systems. In most cases, we can submit claims electronically (even in non-autocross situations). Electronic claims are typically adjudicated faster than paper claims, reducing payment delays while also freeing your staff to focus on business needs.

OmniSYS provides an easy-to-use, self-service Denial Tracking support site which allows your team to effectively research the Medicaid denials and resubmit claims as needed.

Client Reporting and Web Tools

At OmniSYS, we have made significant investments to develop best-in-class reporting and web tools for our customers. To effectively manage your Medicare Part B business, we believe it’s critical you have real-time access to comprehensive, detailed reporting that is simple to use.

OmniTOOLS - Dashboard OmniTOOLS - Aging Report

Our dedicated team of Business Intelligence analysts is responsible for monitoring claim data, identifying trends, and providing recommendations to improve your business. We provide standard and premium reporting packages that offer in-depth access to your data through online, interactive reports. Premium Quarterly Value Reports include over 50 pages of in-depth analysis, data, trends and a comparison to the OmniSYS book-of-business.

Reduce Costs with Real-Time Commercial Insurance Eligibility Verification

Are eligibility denials from commercial insurers impacting your bottom line? If so, OmniSYS offers real-time transactional edits to confirm commercial eligibility for most commercial payers. Our edits verify commercial eligibility for coverage secondary to Medicare, as well as eligibility for primary commercial immunization, DME and medical supply claims.

Instant eligibility and plan coverage verification reduces administration costs and eligibility related denials. Contact us today to learn more about how your company can benefit from OmniSYS’ comprehensive Commercial Eligibility edit services.

Educate Patients with Diabetes Self-Management Training (DSMT)

Did you know that Medicare covers Diabetes Self-Management Training (DSMT) for beneficiaries? OmniSYS is a national processor of DSMT billing services for Medicare Part B in all 50 states. Suppliers who provide DSMT training services to beneficiaries increase the patient’s knowledge about their disease and learn how to exercise better control over their own health. OmniSYS’ DSMT billing service enables suppliers to further expand their role to serve the healthcare needs of patients with diabetes. By providing preventative training for diabetic patients, suppliers directly impact and improve their patients’ healthcare outcomes while decreasing healthcare costs. OmniSYS billing services provide real-time transactional edits for Medicare eligibility, DSMT coverage limitations, allowable pricing and remittance processing. To participate, a supplier’s DSMT program must be accredited by American Diabetes Association (ADA), the American Association of Diabetes Educators (AADE) or Indian Health Services (IHS).

Maximize Savings while Minimizing Costs with Denial Tracking

Rest assured that we’re tracking every penny of every claim to effectively manage your receivable. OmniSYS’ Denial Tracking service further increases profits at least two-to-four percent, by timely and efficiently correcting and resubmitting denied claims. Our dedicated Denial Tracking team has tremendous experience and success working the denials to ensure Medicare payment is received.

We provide retrospective feedback using remittance received from Medicare to improve real-time edits and capitalize on valuable historic data.

Reduce Risks and Understand Coverage Limitations with Commercial Insurance Benefit Verification

Unknown plan limitations or lack of coverage for commercial insurance can be detrimental to your financial results. OmniSYS’ Commercial Insurance Verification reduces significant administrative overhead and unexpected payment delays by identifying coverage details prior to claim submission for new and existing members.

OmniSYS’ Call Center initiates outbound calls on your behalf to verify primary and secondary coverage and determine available benefits for the services rendered. Verification of member name, DOB, gender, member ID, effective date, in-network vs. out-of-network coverage details, prior authorization requirements and deductible information are provided in an electronic response file to help suppliers effectively manage their business. Due to our scale and process efficiencies, OmniSYS can significantly reduce your overhead expenses.