800 788 7871 - 800-788-7871 800-603-7796 ProAct Pharmacy Help Desk: 877-635-9545 MedalistRx Help Desk 855-633-2579 Transaction Header Segment NCPDP Field Name Claim Billing/Claim Rebill Field # Value Payer Payer Situation Usage M M M M M M M 1Ø1-A1 BIN NUMBER VERSION/RELEASE NUMBER TRANSACTION CODE PROCESSOR CONTROL NUMBER TRANSACTION COUNT

 
OptumRx Address: 3515 Harbor Boulevard Costa Mesa, CA 92626-0000 Website: https://WWW.RXSOLUTIONS.COM Telephone: 800-788-7871 Fax 714-825-3608 Mail Order Disposable Medical Supplies . Fancy like applebee

Catamaran/Optum at 1-800-788-7871. Mail Order. Active mail order prescriptions • Existing mail order prescriptions will automatically transfer to PrimeMail, but patients will need to create a new mail order account with Prime in order to ensure payment and delivery. 800-788-7871 Paramount Rx Inc 610210 800-928-4301 PBM Plus, Inc. 610106 800-263-2178 PerformRx (Includes: LA Medicaid and Keystone Mercy) 012353, 600428 800-684-5502 Pharmacy BenefitDirect-PDMI 610020, 014955 800-800-7364 Prime Therapeutics 610455, 004915, 012833, 011552, 015905, 014897, 800-821-4795 ProCare Rx 009430, 013501, 014310, 014194 ...(800) 788-7871 (for coverage verification) (888) 543-1369 or www.optumrx.com (Customer Service) 4 NCDS Healthcare Plan (Rev. January 2021) SUMMARY SCHEDULE OF BENEFITS OptumRx Address: 3515 Harbor Boulevard Costa Mesa, CA 92626-0000 Website: https://WWW.RXSOLUTIONS.COM Telephone: 800-788-7871 Fax 714-825-3608 Mail Order Disposable Medical Supplies Rx BIN: 004336 Rx Group: Rx21CQ. PCN: ADV. Total Benefit Solutions (Aetna International) 610502 (Aetna) PCN: 00670000. United Healthcare HMO. Rx Vendor: OPTUMRx Rx BIN: 610279 Rx PCN: 9999 Rx Grp: UHCNICE Service Number: 800-788-7871. United Healthcare PPO. Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871.Allied International Union Med Impact NY 003585 31905 800/788-2949 Alpha Barnes MaxorPlus TX 005377 8253 800-687-0707 American Health Care AHC National 610118 AHC 800/872-8276 American Medical Society Pres Solutions National 610494 9999, Grp AMS 800/788-7871 AmeriChoice Pres Solutions NY/NJ 610494 9999, AMNY/ AMNS 800/788-7871 Amerigroup ... Medical Plans. Phone: Please check the number on the back of the health plan ID card. Online: myuhc.com. Technical Support: 1-877-844-4999. Behavioral Health: myuhc.com or liveandworkwell.com 1-800-842-2065. OptumRx®. Phone: 1-800-788-7871. Authorization: 1-800-711-4555. exceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to this review?RxHelp.ca. RxHelp card programs allow patients to benefit from payment assistance on their medication. Let us Help choose the best card for you. New RxHelp mobile app! The RxHelp mobile app is easy-to-use and saves you money on prescriptions. Best of all, you always have the discount card on your phone. Delta Dental 800-765-6003 www.deltadentalins.com HMC HealthWorks 866-268-2510 https://hmc.personaladvantage.com (Access Code: SCDBF) Kaiser 800-464-4000 www.kp.org OptumRx 800-788-7871 www.optumrx.com Podiatry Plan, Inc. 800-367-7762 www.podiatryplan.com United Concordia 800-937-6432 www.unitedconcordia.com 1-800-464-4000 (English) 1-800-788-0616 (Spanish) Appointments and Nurse Advice Line: ... 1-800-788-7871: iphone. Android. Teamsters’ Assistance Program (TAP) WebsitePharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ MFor urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028. This document and others if attached contain information that is privileged, confidential and/or may contain protected health information (PHI). exceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788- 7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to o For Pharmacists – 800-788-7871 • Member Name . ID CARDS . You may also print a temporary ID card beginning August 1, 2015 by registering and logging onto .Service Number: 800-788-7871 United Healthcare PPO Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871 United Healthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871 Western Health Advantage Rx Vendor: OptumRx RX BIN 610011 PCN: IRX Rx Vendor: OPTUMRx Rx BIN: 610279 Rx PCN: 9999 Rx Grp: UHCNICE Service Number: 800-788-7871 Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHCNICE Service Number: 800-788-7871. UnitedHealthcare PPO. UnitedHealthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999. Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871Area Code & Prefix Service Provider Location Effective; 502-698: TELEPORT COMMUNICATIONS AMERICA, LLC - KY: Shepherdsville, KY: Oct 02, 2023: 346-691: CELLCO PARTNERSHIP DBA VERIZON WIRELESS - TXAug 10, 2022 · Service Number: 800-788-7871 : United Healthcare PPO: Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871 : United Healthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871 : Western Health Advantage: Rx Vendor: OptumRx Rx BIN 610011 ... Pharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 Transaction Header Segment NCPDP Field Name Claim Billing/Claim Rebill Field # Value Payer Payer Situation Usage M M M M M M M 1Ø1-A1 BIN NUMBER VERSION/RELEASE NUMBER TRANSACTION CODE PROCESSOR CONTROL NUMBER TRANSACTION COUNT SERVICE PROVIDER ID QUALIFIEROptumRx: 800-788-7871 FlexScripts: 800-603-7796 ProAct: 877-635-9545 MedalistRx: 855-633-2579 Other versions supported: ONLY D.0 CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) Mexceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788- 7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to All other Plans: 800-788-7871 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field ... All other Plans: 800-788-7871 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field ... 800-788-7871 Paramount Rx Inc 610210 800-928-4301 PBM Plus, Inc. 610106 800-263-2178 PerformRx (Includes: LA Medicaid and Keystone Mercy) 012353, 600428 800-684-5502 Pharmacy BenefitDirect-PDMI 610020, 014955 800-800-7364 Prime Therapeutics 610455, 004915, 012833, 011552, 015905, 014897, 800-821-4795 ProCare Rx 009430, 013501, 014310, 014194 ... All other Plans: 800-788-7871 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field ...Pharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1 -A1 BIN NUMBER (see above) M 1Ø2 -A2 VERSION/RELEASE NUMB ER DØ M 1Ø3 -A3 TRANSACTION CODE B1, B3 MPHARMACY BIN & PCN NUMBERS The Rx BIN number is a 6-digit number health plans use to process electronic pharmacy claims. Rx BIN and PCN numbers are used by new members to pick up a new prescription (or refill) prior to having a new ID card or showing up in the new Carrier’s Rx system.Pharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ MPharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 Transaction Header Segment NCPDP Field Name Claim Billing/Claim Rebill Field # Value Payer Payer Situation Usage M M M M M M M 1Ø1-A1 BIN NUMBER VERSION/RELEASE NUMBER TRANSACTION CODE PROCESSOR CONTROL NUMBER TRANSACTION COUNT SERVICE PROVIDER ID QUALIFIER OptumRx Address: 3515 Harbor Boulevard Costa Mesa, CA 92626-0000 Website: https://WWW.RXSOLUTIONS.COM Telephone: 800-788-7871 Fax 714-825-3608 Mail Order Disposable Medical Supplies Service Number: 800-788-7871 United Healthcare PPO Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871 United Healthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871 Western Health Advantage Rx Vendor: OptumRx RX BIN 610011 PCN: IRX9665 Rockside Road, Valley View, Ohio 44125 Pension: 216-781-6869 H&W: 216-781-6858 All other Plans: 800-788-7871 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field ... exceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788- 7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to 1-800-788-7871 or 1-800-797-9791 This plan: uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use ...Allied International Union Med Impact NY 003585 31905 800/788-2949 Alpha Barnes MaxorPlus TX 005377 8253 800-687-0707 American Health Care AHC National 610118 AHC 800/872-8276 American Medical Society Pres Solutions National 610494 9999, Grp AMS 800/788-7871 AmeriChoice Pres Solutions NY/NJ 610494 9999, AMNY/ AMNS 800/788-7871 Amerigroup ...Pharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 Transaction Header Segment NCPDP Field Name Claim Billing/Claim Rebill Field # Value Payer Payer Situation Usage M M M M M M M 1Ø1-A1 BIN NUMBER VERSION/RELEASE NUMBER TRANSACTION CODE PROCESSOR CONTROL NUMBER TRANSACTION COUNT SERVICE PROVIDER ID QUALIFIER Catamaran/Optum at 1-800-788-7871. Mail Order. Active mail order prescriptions • Existing mail order prescriptions will automatically transfer to PrimeMail, but patients will need to create a new mail order account with Prime in order to ensure payment and delivery.o For Pharmacists – 800-788-7871 • Member Name . ID CARDS . You may also print a temporary ID card beginning August 1, 2015 by registering and logging onto .OptumRx: 800-788-7871 FlexScripts: 800-603-7796 ProAct: 877-635-9545 MedalistRx: 855-633-2579 Other versions supported: ONLY D.0 CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) MNov 4, 2022 · Rx Vendor: OPTUMRx Rx BIN: 610279 Rx PCN: 9999 Rx Grp: UHCNICE Service Number: 800-788-7871 : United Healthcare PPO : Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871 : United Healthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871 LiveHealth Online: 24/7 video chat access to doctors and therapists from the comfort of your home. 100% coverage for preventive care when you see Anthem network doctors (including routine preventive health screenings, immunizations, and routine annual exams) A wealth of tools and resources available to help you live your healthiest life.See the benefits. Our research shows Optum Home Delivery reduces medication adherence barriers, drives greater health outcomes and lowers total cost of care.. Higher medication adherence - We analyzed 3 chronic conditions; participants had a 20%+ higher medication adherence with home delivery 90-day vs. 30-day supply at retail.The phone number 800-788-7871 is used by PRESCRIPTIONS SOLUTIONS located in CYPRESS, CA If you have received, or continue to receive, unwanted phone calls or text messages from 800-788-7871, please take a minute and let us know . This phone number can appear in different ways, such as +1 800-788-7871 or (800) 788-7871 or simply just 8007887871 .A reverse phone lookup is an excellent tool for figuring out who called you. Whether it's a missed call, a blocked number or a wrong number. Who Called Me is a free reverse phone lookup tool and website that allows users to look up the telephone number of the person who called them. It searches millions of records to identify that caller's name ...OptumRx: 800-788-7871. FlexScripts: 800-603-7796. ProAct: 877-635-9545. MedalistRx: 855-633-2579. Other versions supported: ONLY CLAIM BILLING/CLAIM REBILL TRANSACTION. Transaction Header Segment Claim Billing/Claim Rebill Payer Field # NCPDP Field Name Value Payer Situation Usage 1 1-A1 BIN NUMBER (see above) M.1. Instant Checkmate - Largest reverse phone lookup directory. This company is known for its all-inclusive public records checks. It allows the client to do background checks, reverse phone ...1-800-788-2949 MedImpact Greystone & Co., Inc 003585 ASPROD1 GRE01 Commercial VA 1-800-788-2949 MedImpact Tanner Health System 003585 ASPROD1 PHI03 Commercial Georgia 1-877-403-6031 1-800-729-1174 MedImpact 1.1.2015. EFFECTIVE 07.27.2015 Subject to Change Page 40PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk ...The phone number 800-788-7871 is used by PRESCRIPTIONS SOLUTIONS located in CYPRESS, CA If you have received, or continue to receive, unwanted phone calls or text messages from 800-788-7871, please take a minute and let us know . This phone number can appear in different ways, such as +1 800-788-7871 or (800) 788-7871 or simply just 8007887871 .Pharmacy Help Desk OptumRx 800-788-7871 MedalistRx Help Desk 855-633-2579 Pharmacy Help Desk FlexScripts 800-603-7796 Pharmacy Help Desk Cigna 8ØØ-244-6224 Other ... Allied International Union Med Impact NY 003585 31905 800/788-2949 Alpha Barnes MaxorPlus TX 005377 8253 800-687-0707 American Health Care AHC National 610118 AHC 800/872-8276 American Medical Society Pres Solutions National 610494 9999, Grp AMS 800/788-7871 AmeriChoice Pres Solutions NY/NJ 610494 9999, AMNY/ AMNS 800/788-7871 Amerigroup ... call 1-800-788-7871. Generic drugs $12 copay / prescription Deductible does not apply. Not Covered • You must use a Participating Pharmacy listed in the UFCW Participating Pharmacy Directory of the Southern California Drug Benefit Fund or no coverage. • Your cost sharing applies to the prescriptionexceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to this review?Preferred Care Partners: 1 -800 591 6144 Medica Healthcare Plans: 1 -866 273 9444 All other plans: 1 -800 788 7871. Author: SYSTEM Created Date:Catamaran/Optum at 1-800-788-7871. Mail Order. Active mail order prescriptions • Existing mail order prescriptions will automatically transfer to PrimeMail, but patients will need to create a new mail order account with Prime in order to ensure payment and delivery.Catamaran/Optum at 1-800-788-7871. Mail Order. Active mail order prescriptions • Existing mail order prescriptions will automatically transfer to PrimeMail, but patients will need to create a new mail order account with Prime in order to ensure payment and delivery.exceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to this review?LiveHealth Online: 24/7 video chat access to doctors and therapists from the comfort of your home. 100% coverage for preventive care when you see Anthem network doctors (including routine preventive health screenings, immunizations, and routine annual exams) A wealth of tools and resources available to help you live your healthiest life.If the patient is not able to meet the above standard prior authorization requirements, please call 1-800-711-4555. For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028.Preferred Care Partners: 1 -800 591 6144 Medica Healthcare Plans: 1 -866 273 9444 All other plans: 1 -800 788 7871. Author: SYSTEM Created Date: 1-800-788-2949 MedImpact Greystone & Co., Inc 003585 ASPROD1 GRE01 Commercial VA 1-800-788-2949 MedImpact Tanner Health System 003585 ASPROD1 PHI03 Commercial Georgia 1-877-403-6031 1-800-729-1174 MedImpact 1.1.2015. EFFECTIVE 07.27.2015 Subject to Change Page 40PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk ... 800-788-7871 Paramount Rx Inc 610210 800-928-4301 PBM Plus, Inc. 610106 800-263-2178 PerformRx (Includes: LA Medicaid and Keystone Mercy) 012353, 600428 800-684-5502 Pharmacy BenefitDirect-PDMI 610020, 014955 800-800-7364 Prime Therapeutics 610455, 004915, 012833, 011552, 015905, 014897, 800-821-4795 ProCare Rx 009430, 013501, 014310, 014194 ... 9665 Rockside Road, Valley View, Ohio 44125 Pension: 216-781-6869 H&W: 216-781-6858 OptumRx Provider Manual: 2016 2nd edition 4 The information contained in this document is proprietary and confidential to OptumRx. B. Images used in the PM Friendly FYI for our valued Network Pharmacy Providers Allied International Union Med Impact NY 003585 31905 800/788-2949 Alpha Barnes MaxorPlus TX 005377 8253 800-687-0707 American Health Care AHC National 610118 AHC 800/872-8276 American Medical Society Pres Solutions National 610494 9999, Grp AMS 800/788-7871 AmeriChoice Pres Solutions NY/NJ 610494 9999, AMNY/ AMNS 800/788-7871 Amerigroup ...MedImpact Commercial 003585, 011917, P: 800-788-2949 Commercial Extended Day 012882, 014988, E: [email protected] Discount Card Programs 015400, 015441, Credentialing: [email protected] Medicaid 015517, 015574, Medicare D 015921, 017142, Medicare D Extended Day 018050, 018596, Medicare D LTC 018605, 020008 ... Aug 10, 2022 · Service Number: 800-788-7871 : United Healthcare PPO: Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871 : United Healthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871 : Western Health Advantage: Rx Vendor: OptumRx Rx BIN 610011 ... Pharmacy Help Desk OptumRx 800-788-7871 MedalistRx Help Desk 855-633-2579 Pharmacy Help Desk FlexScripts 800-603-7796 Other versions supported: ONLY D.0 Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1 -A1 BIN NUMBER (see above) MFor urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028. ______________________________________________________________________________________________________________OptumRx: 800-788-7871 FlexScripts: 800-603-7796 ProAct: 877-635-9545 MedalistRx: 855-633-2579 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTIONAll other Plans: 800-788-7871 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field ...800-788-7871 800-603-7796 ProAct Pharmacy Help Desk: 877-635-9545 MedalistRx Help Desk 855-633-2579 Transaction Header Segment NCPDP Field Name Claim Billing/Claim Rebill Field # Value Payer Payer Situation Usage M M M M M M M 1Ø1-A1 BIN NUMBER VERSION/RELEASE NUMBER TRANSACTION CODE PROCESSOR CONTROL NUMBER TRANSACTION COUNT Other ways to submit a prior authorization. Having difficulties with ePA? You can submit a verbal PA request. Call 1-800-711-4555, 5 a.m. – 10 p.m. PT, Monday-Friday and 6 a.m. – 3 p.m. PT, Saturday. If you cannot submit requests to the OptumRx® PA department through ePA or telephone, click here. Top. Allied International Union Med Impact NY 003585 31905 800/788-2949 Alpha Barnes MaxorPlus TX 005377 8253 800-687-0707 American Health Care AHC National 610118 AHC 800/872-8276 American Medical Society Pres Solutions National 610494 9999, Grp AMS 800/788-7871 AmeriChoice Pres Solutions NY/NJ 610494 9999, AMNY/ AMNS 800/788-7871 Amerigroup ... Pharmacy Help Desk must be contacted for assistance at 800-788-7871, available 24 hours a day, 7 days a week. The help desk can also assist in initiating a request for OptumRx to research the prescriber’s DEA license in question and perform a data validation and update. This process should be followed for those Prescribers who would like their

exceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to this review?. Luxureart

800 788 7871

Pharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ MIf the patient is not able to meet the above standard prior authorization requirements, please call 1-800-711-4555. For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028.For urgent or expedited requests please call 1-800-711-4555. This form may be used for non-urgent requests and faxed to 1-844-403-1028. This document and others if attached contain information that is privileged, confidential and/or may contain protected health information (PHI). call 1-800-788-7871. Generic drugs $12 copay / prescription Deductible does not apply. Not Covered • You must use a Participating Pharmacy listed in the UFCW Participating Pharmacy Directory of the Southern California Drug Benefit Fund or no coverage. • Your cost sharing applies to the prescriptionOther ways to submit a prior authorization. Having difficulties with ePA? You can submit a verbal PA request. Call 1-800-711-4555, 5 a.m. – 10 p.m. PT, Monday-Friday and 6 a.m. – 3 p.m. PT, Saturday. If you cannot submit requests to the OptumRx® PA department through ePA or telephone, click here. Top. Rx BIN: 004336 Rx Group: Rx21CQ. PCN: ADV. Total Benefit Solutions (Aetna International) 610502 (Aetna) PCN: 00670000. United Healthcare HMO. Rx Vendor: OPTUMRx Rx BIN: 610279 Rx PCN: 9999 Rx Grp: UHCNICE Service Number: 800-788-7871. United Healthcare PPO. Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871.Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Rx Grp: UHC Service Number: 800-788-7871. United Healthcare PPO (Large Group) Rx Vendor: OPTUMRx Rx Bin: 610279 Rx PCN: 9999 Key Accounts Rx Grp: UHEALTH Service Number: 800-788-7871. Western Health Advantage. Rx Vendor: OptumRx Rx BIN 610011. PCN: IRX.exceeding 4 grams per day, please have the patient’s pharmacy contact the OptumRx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Are there any other comments, diagnoses, symptoms, medications tried or failed, and/or any other information the physician feels is important to this review?OptumRx: 800-788-7871 FlexScripts: 800-603-7796 ProAct: 877-635-9545 MedalistRx: 855-633-2579 Other versions supported: ONLY D.0 CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M MedImpact Commercial 003585, 011917, P: 800-788-2949 Commercial Extended Day 012882, 014988, E: [email protected] Discount Card Programs 015400, 015441, Credentialing: [email protected] Medicaid 015517, 015574, Medicare D 015921, 017142, Medicare D Extended Day 018050, 018596, Medicare D LTC 018605, 020008 ... 1-800-788-2949 MedImpact Greystone & Co., Inc 003585 ASPROD1 GRE01 Commercial VA 1-800-788-2949 MedImpact Tanner Health System 003585 ASPROD1 PHI03 Commercial Georgia 1-877-403-6031 1-800-729-1174 MedImpact 1.1.2015. EFFECTIVE 07.27.2015 Subject to Change Page 40PBM/Payor Plan Name/Contract Name BIN PCN GROUP Type Network Location Help Desk ...Pharmacy Help Desk OptumRx 800-788-7871 Other versions supported: ONLY D.0 Transaction Header Segment Claim Billing/Claim Rebill Field # NCPDP Field Name Value Payer Usage Payer Situation 1Ø1-A1 BIN NUMBER (see above) M 1Ø2-A2 VERSION/RELEASE NUMBER DØ M 1Ø3-A3 TRANSACTION CODE B1, B3 M OptumRx: 800-788-7871. FlexScripts: 800-603-7796. ProAct: 877-635-9545. MedalistRx: 855-633-2579. Other versions supported: ONLY CLAIM BILLING/CLAIM REBILL TRANSACTION. Transaction Header Segment Claim Billing/Claim Rebill Payer Field # NCPDP Field Name Value Payer Situation Usage 1 1-A1 BIN NUMBER (see above) M.Pharmacy Help Desk OptumRx 800-788-7871 MedalistRx Help Desk 855-633-2579 Pharmacy Help Desk FlexScripts 800-603-7796 Pharmacy Help Desk Cigna 8ØØ-244-6224 Other ... Jul 28, 2021 · 800-788-7871. Get a call from 8007887871? Read comments below to find details about this number. Report unwanted calls to help identify who is calling. .

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