Overview
OmniSYS’ Drug Claims Management enables Health Plans to manage drug claims billed in medical claim formats including ASC X12N 837P, CMS-1500 and more. OmniSYS receives claims in the Health Plan’s format and applies robust NCPDP Standards which allow for the efficient processing of medical drug claims at the same level as pharmacy claims. Data can be captured for analysis, repriced to MAC, ASP or FirstDataBank pricing, and edited for compliance to the Health Plan’s specifications for consideration of eligibility, benefits and reimbursement.

How DCMS Works
DCMS processing requires providers to enter a drug’s National Drug Code (“NDC”) to each drug line on a medical claim. All medical claim formats either designate a line-of-service field for the entry of NDC or contain a line-of-service field that is appropriate for NDC entry. Many health plans already require the entry of NDC on medical drug claims.

DCMS offers the following services: