Medicaid & Commercial Insurance
OmniSYS offers services for billing for Medicaid, Commercial Insurance and Medicaid Secondary Coordination of Benefits (COB) Claims.

Originally, CareCLAIM from OmniSYS processed Medicare only, Medicare/Medicaid and Medicare/Supplemental Insurance Claims as well as Medicare Secondary Coordination of Benefits (COB) Claims. We now also accept Medicaid and Commercial Insurance Primary claims as well as Non-Autocross Medicaid Secondary COB claims.

Medicaid and Commercial Insurance Claims are submitted to CareCLAIM from your existing pharmacy management system. When possible, CareCLAIM will return a paid response that includes payor allowed amounts and coinsurance. If allowed amounts for a plan are not available, CareCLAIM will return the Usual and Customary (U&C). Medicaid and Commercial Insurance Claims are submitted electronically via HIPAA-compliant ANSI 837 standards.

For all Medicare/Medicaid Non-Autocross scenarios, the Medicare primary portion of the claim is submitted to the DMERC while the Medicaid Secondary COB portion is placed on-hold pending receipt of Medicare remittance information, which is required for submission of the Medicaid Secondary COB claim. Medicaid Secondary COB claims are submitted using HIPAA-mandated NCPDP or ANSI Standards depending on whether the item dispensed is for drugs or supplies.