844-403-1027 (2024)

FAQs

How long does OptumRx prior authorization take? ›

Once your PA has been submitted and received, it usually takes 48 to 72 hours to process. If your PA request needs additional review, it may take longer. If your doctor submits a PA request electronically, they may receive approval within minutes of submitting the request.

For all other questions, call the OptumRx Prior Authorization Department at 1-800-711-4555.

If you have questions or want to speak with an Optum Rx Prior Authorization Advocate, call 1-800-711-4555.

Optum Rx Pharmacy Helpdesk at (800) 788-7871 at the time they are filling the prescription for a one-time override. Optum Rx has partnered with CoverMyMeds to receive prior authorization requests, saving you time and often delivering real-time determinations.

Provide correct and complete patient information.

One of the primary reasons that Prior Authorizations take so long to process is that incomplete or incorrect information is submitted to the health insurance provider. Take note that the smallest details matter.

If a service is being denied by most health plans, you may have a systems problem such as improper coding practices. If the denial is coming from only one health plan, contact the plan and find out what their coverage position is on that particular procedure or drug.

Many people are receiving calls, primarily on their cell phones, from Optum RX, which they have not consented to receive. These are automated calls or robocalls, which violate the Telephone Consumer Protection Act (TCPA).

Once OptumRx receives your complete order for a new prescription, your medications should arrive within ten business days. Completed refill orders should arrive to your home in about seven business days.

How do I appeal OptumRx denial? For more information on the OptumRx Claim Reimbursem*nt Review/Appeal request process: Contact OptumRx at 1-800-613-3591 extension 9, Monday through Friday, 6 AM 4 PM PT, or your OptumRx Provider Liaison; or the Call Center at 800-424-5815 to request a reimbursem*nt price.

OptumRx Inc., a prescription drug benefit provider, has agreed to pay $20 million to resolve allegations that it improperly filled certain opioid prescriptions in violation of the Controlled Substances Act.

Is OptumRx owned by UnitedHealthcare? ›

Optum Rx is an affiliate of UnitedHealthcare Insurance Company.

Who is OptumRx®? OptumRx is your CalPERS pharmacy benefit manager for Anthem, Health Net, Sharp, UnitedHealthcare, and Western Health Advantage. Our goal is to provide safe, easy and cost-effective ways for you to get the medication you need.

Once OptumRx receives your complete order for a new prescription, your medications should arrive within ten business days. Completed refill orders should arrive to your home in about seven business days. If we need to contact you or your doctor with questions, it may take longer to receive your order.

Taking into consideration the complexity of a prior authorization request, the prior authorization process selected by a healthcare provider, requirements set out in individual health plans, and any subsequent appeals process, a prior authorization (PA) can take anywhere from same day to over a month to process.

A preauthorization charge on a credit or debit card typically lasts for about five to seven days, but this duration can vary depending on the card issuer's policies and the type of transaction. Some banks may keep the hold for up to 14 days.

Please refer to the specific coverage information you receive after you enroll. We typically decide on requests for prior authorization for medical services within 72 hours of receiving an urgent request or within 15 days for non-urgent requests.