800 788 7871 - 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

 
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 .... Ramirez liquor wine and kegs

Kaiser Permanente – Northern CA. HMO Rx BIN: 3585 Rx Group: Not Required Tax ID: 94-1340523 Medicare Part D Rx BIN: 11842 Rx Group: NC Tax ID: 94-1340523 COB Address P.O. Box 7012 Downey, CA 90242. Rx PCN for MMA: NCCMS Rx PCN for HDHP: NCHDP Rx PCN for HMO: 70000. Kaiser Permanente – Southern CA.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. Pharmacy Help Desk OptumRx 800-788-7871 MedalistRx Help Desk 855-633 -2579 . Pharmacy Help Desk FlexScripts 800-603-7796 .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 M 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 ...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: 800-788-7871PCN: 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.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). (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 Jul 13, 2015 · 800-788-7871 Paramount Rx Inc National Funded Network, National Non Funded Network 610210 800-928-4301 PBM Plus, Inc. National and Limited Networks 610106 800-263-2178 PerformRx National Network, Medicare D, LA Medicaid, Keystone Mercy 012353, 600428 800-684-5502 Pharmacy BenefitDirect-PDMI National Networks, Restricted Networks, (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 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 ...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.comService Number: 800-788-7871. PCN . United Healthcare PPO (Large Group) Rx BIN Number. Rx Vendor: OPTUMRx Rx Bin: 610279. Rx PCN: 9999 Key Accounts Rx Grp: UHEALTHPHARMACY 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.1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203.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 ... Coast Longshore Division Caucus unanimously votes to send tentative agreement to membershipPharmacy 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 ...1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203.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 ...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 ...Health Care Plans United Healthcare (PPO, EPO, or HDHP) – 877-440-5982 www.myuhc.com MPS Group Medicare Advantage Plan – 866-487-9303 www.UHCRetiree.com Prescription Drugs OptumRX – 800-788-7871 www.optumrx.com Vision Insurance National Vision […]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?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 ... 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: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 ...1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203.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 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 ... 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 ... Nov 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 800-788-7871 Paramount Rx Inc National Funded Network, National Non Funded Network 610210 800-928-4301 PBM Plus, Inc. National and Limited Networks 610106 800-263-2178 PerformRx National Network, Medicare D, LA Medicaid, Keystone Mercy 012353, 600428 800-684-5502 Pharmacy BenefitDirect-PDMI National Networks, Restricted Networks,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 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.comAll other Plans: 800-788-7871 Other versions supported: ONLY D.0 . CLAIM BILLING/CLAIM REBILL TRANSACTION Transaction Header Segment Claim Billing/Claim Rebill Field ... For technical website issues or password resets:1-800-788-4863 TTY (for the hearing impaired): 711 Physician Contacts: Prior authorization or exception request: 1-800-711-4555, option 2 If you are having a medical crisis, please call 911, or contact your local emergency assistance service immediately.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 ...Nov 5, 2022 · 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. 9665 Rockside Road, Valley View, Ohio 44125 Pension: 216-781-6869 H&W: 216-781-6858 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. Customer Service Center (877) 453-9198 Pharmacy (800) 788-7871 CCSB Agent Service Center (855) 777-6782 Group Service / Administration (800) 591-9911 CCSB New Business Sales (844) 332-8384 Enrollment & Eligibility Fax (866) 372-1316 Delta Dental VSP Member Services Member Services (800) 877-7195A 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 ... 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.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 ProvidersIf you are covered under an Anthem Blue Cross Indemnity medical plan option, please refer to your Summary Plan Description (SPD), contact the Trust Fund Office or contact OptumRx at 800-788-7871 to determine the exact amount of your prescription co-pays.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.comDelta 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 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 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 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 MOptumRx: 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 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 ... Aug 10, 2022 · Service Number: 800-788-7871 : United Healthcare PPO: Rx Supplier: 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 Reports Rx Grp: UHEALTH Service Number: 800-788-7871 : Western Your Advantage: Rx Vendor: OptumRx Rx BIN 610011 ... 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 ... 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.Mailing Address BOX 29044 Hot Springs, AR 71903. Member Website Medical & Pharmacy Member Service TFN 800-357-1371. UHC Provider Website UHC Provider TFN 877-842-3210. OptumRx Prior Auth TFN. 800-788-7871 (access to Prior Auth Tool via ). OptumRx Pharmacist TFN 800-788-7871. 800-788-7871 (access to Prior Auth Tool via www.unitedhealthcareonline ...POS message: LA Opioid Dup Therapy, MD Cnslt: use TD-M0-1G; Exmpt:use PPS code; RxHelp 800-788-7871 Reject code: 88. Pharmacist conducts additional safety review to determine if the patient’s opioid use is safe and clinically appropriate. Use standard NCPDP PPS codes to resolve at POS. 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 POS message: LA Opioid Dup Therapy, MD Cnslt: use TD-M0-1G; Exmpt:use PPS code; RxHelp 800-788-7871 Reject code: 88. Pharmacist conducts additional safety review to determine if the patient’s opioid use is safe and clinically appropriate. Use standard NCPDP PPS codes to resolve at POS. POS message: LA Opioid Dup Therapy, MD Cnslt: use TD-M0-1G; Exmpt:use PPS code; RxHelp 800-788-7871 Reject code: 88. Pharmacist conducts additional safety review to determine if the patient’s opioid use is safe and clinically appropriate. Use standard NCPDP PPS codes to resolve at POS. 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: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 ... 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 M 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 M 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 ...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: IRXOptumRx: 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) M800-788-7871 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 ... 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 ...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 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 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 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?(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 BENEFITSPCN: 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.Service Number: 800-788-7871 : United Healthcare PPO: Rx Supplier: 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 Reports Rx Grp: UHEALTH Service Number: 800-788-7871 : Western Your Advantage: Rx Vendor: OptumRx Rx BIN 610011 ...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 ... OptumRx 800-788-7871 www.optumrx.com Podiatry Plan of California (PPOC) 800-367-7762 www.podiatryplan.com UnitedHealthcare (UHC) 800-624-8822 www.MyUHC.comPCN: 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: 800-788-7871.1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203. All other Plans: 800-788-7871 Please Distribute Immediately. Thank you. Title: HI QExA Notification ICD9 Author: RxSolutions Created Date: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 . 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.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 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.comPharmacy 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

1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203.. 44 346 pill

800 788 7871

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 TRANSACTIONPharmacy 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 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) M1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203.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).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 ... 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 MOptumRx 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 ProvidersOptumRx: 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) M1-234-201. Mahoning. Youngstown. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-202. Summit. Akron. Cellco Partnership Dba Verizon Wireless - Oh. 1-234-203. Nov 5, 2022 · 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. 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 COUNTOther 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. 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 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 ...Pres Solutions National 610494 9999 800/788-7871<br /> PacificSource Health Caremark National 610415 Varies 800-345-5413<br /> Paradigm- Missouri<br />The Official Whitepages. Area Code 323 phone numbers . State: California . In service since: 1998 Landlines: 572 Wireless prefixes: 206 Carriers: 40 Counties: 3 ZIP codes: 37 Major cities: Los Angeles, Torrance, Burbank, South El Monte, Santa AnaRx 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..

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