Overview
OmniSYS is focused on value-added services like Retrospective Feedback, that extend beyond routinely submitting Medicare Part B claims. These value-added services evolved through an iterative process of data analysis and refinements to business rules that are intended to enhance the patient’s point-of-sale experience while, at the same time, reducing “bad debt expense” and “days-sales-outstanding”.

Prospective edits that are supplemented by retrospective remittance feedback to ensure “clean” claims are submitted to Medicare, which minimizes first-time denials. Importantly, these edits extend beyond routinely submitting Medicare Part B claims. Rather they focus on identifying potential supplemental payors (Medicaid, Commercial Insurance, etc.) at the point-of-sale in order to calculate appropriate patient cost-share, thereby enhancing the patient’s experience. Customized business rules include prospective edits and special messaging for client-specific needs.

Retrospective feedback supplements prospective edits by applying the ANSI 835 remittance returned for each claim.  For example, retrospective feedback is used prospectively to identify situations where supplemental insurance was not reported initially at the point-of-sale; but, subsequently, supplemental insurance was indicated through remittance (ASNI 835), thereby avoiding over collecting/refunding patient coinsurance and affecting goodwill.

How it Works
OmniSYS’ retrospective feedback processes utilize information returned in the ANSI 835 remittance.  The information is used to provide prospective edits and messaging on future claims.  An example of the retrospective feedback process relates to coordination of benefits claims.  OmniSYS compares secondary insurance information reported by the pharmacy at the point-of-sale to COBA ID information for State Medicaid and other crossover payors reported in the ANSI 835 remittance information.  OmniSYS uses the secondary information reported in the ANSI 835 remittance file to message the pharmacy on subsequent claims if secondary insurance information reported by the pharmacy differs from what is reported in the ANSI 835 remittance file.