Optum Rx to Manage Prior Authorization and Step Therapy Requests

Nov 04, 2024

1 minute

Optum Rx to Manage Prior Authorization and Step Therapy Requests

On January 1, 2025, Optum Rx will start managing prior authorization and step therapy requests for prescription drugs for members of the plan offered by Golden Rule Insurance Company in certain states, in an effort to make the process more streamlined using UnitedHealthcare's clinical criteria for the prescription benefit management of those clients.

This change applies to:

Alabama
Arkansas
Colorado
Iowa
Kansas
Kentucky
Maryland
Michigan
Mississippi
Nebraska
Nevada
Ohio
Oklahoma
South Carolina
Tennessee
Virginia
Wisconsin
West Virigina
Wyoming

Streamlined Prior Authorization Requests

Optum Rx also provided providers with another two avenues for requesting prior authorizations: Online submissions at the Prior Authorization for Prescribers webpage, and call requests made through Optum Rx's prior authorization department at 800-711-4555. Now, this may help streamline submittals across different avenues, thus perhaps making provider approvals easier.

Real-Time Benefit Checks with PreCheck MyScript

Prescribers can also take advantage of the services offered by PreCheck MyScript, a digital benefit tool, to check coverage and pharmacy benefits for the UnitedHealthcare member. Using the feature, prescribers can rapidly run pharmacy trial claims and obtain information regarding coverage that can help inform the decision-making process to ensure patient care is appropriately directed.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

Post Tabs

Latest

Popular

Detailed Guide by Capline on How to Code for Telehealth

April 17, 2026

Medicare Telehealth Coverage Extended Through 2027

April 17, 2026

How to Update the Demographic Data in Medical Documents

April 10, 2026

1 2 3 … 178 Next »

Testimonials

It has been a wonderful experience working with Sean. He made the credentialing process a breeze with his knowledge and communication skills. I highly recommend Capline.

I

Islamorada Dentistry

Rylan is wonderfull representetive, and very quick to complete all his task. We recomend his services, great company and great costumer service. We give him a 5 star.

D

Dentricity Dental Berkeley

Myra Claire was exceptionally professional and efficient in ushering me through the credentialing process! She maintained communication and was very responsive when I had questions! Very pleased!