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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 . Coc xianxia

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 ProvidersOther 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.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 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.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 ... 1-800-464-4000 (English) 1-800-788-0616 (Spanish) Appointments and Nurse Advice Line: ... 1-800-788-7871: iphone. Android. Teamsters’ Assistance Program (TAP) Website 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). 9665 Rockside Road, Valley View, Ohio 44125 Pension: 216-781-6869 H&W: 216-781-6858Pharmacy 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 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.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) MCustomer 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) 877-7195exceeding 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?calling 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 prescription drug out-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 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.comOptumRx 800-788-7871 www.optumrx.com Podiatry Plan of California (PPOC) 800-367-7762 www.podiatryplan.com UnitedHealthcare (UHC) 800-624-8822 www.MyUHC.comOptumRx: 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) MPhone (toll-free): 800-357-0978 Mon-Fri: 8am to 8pm (Eastern) Website: www.myuhc.com United Healthcare, Attn: Claims PO Box 30555 Salt Lake City, UT 84130 Fax: 801-567-5499 OptumRx Customer Service (toll-free): 800-788-7871 • Claim & Benefit Questions • Verify Eligibility • Request ID Cards • Physician VerificationPharmacy 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 QUALIFIERFor 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 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.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 TRANSACTIONService 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: UHEALTHo 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 .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.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 ...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 prescription 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).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. 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 MCoast Longshore Division Caucus unanimously votes to send tentative agreement to membership 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 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. 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) M (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 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.or liveandworkwell.com 1-800-842-2065 OptumRx® • Phone: 1-800-788-7871 Authorization: 1-800-711-4555 • Online: optumrx.com Dental National Options PPO (10, 20 or 30) • Phone: 1-877-816-3596 • Online: myuhc.com California Select Managed Care DHMO • Phone: 1-877-813-4259 • Online: myuhc.com Vision • Phone: 1-800-638-3120PHARMACY 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 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 ...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) Website1-800-788-2949 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: 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. Prescription Solutions. (800) 788-7871. This website is intended to be accessible and usable by people with and without disabilities. 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 MPOS 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. 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 MPhone (toll-free): 800-357-0978 Mon-Fri: 8am to 8pm (Eastern) Website: www.myuhc.com United Healthcare, Attn: Claims PO Box 30555 Salt Lake City, UT 84130 Fax: 801-567-5499 OptumRx Customer Service (toll-free): 800-788-7871 • Claim & Benefit Questions • Verify Eligibility • Request ID Cards • Physician Verificationexceeding 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?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?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 ...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) WebsiteCatamaran/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.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 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) 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 Mcall 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 prescription 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 ...Administrative Office (707) 864-3300 Toll Free 1-888-245-5005. Amplifon Hearing Health Care 888-417-5097 TTY:711 www.amplifonusa.com/lp/norcalcementmasonsexceeding 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 ... 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: IRXThe 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 AnaPharmacy 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 theirA 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 ...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.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 QUALIFIERexceeding 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?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 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 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,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 Providers800-788-7871, Consider Naloxone for safety Reject code(s): 88+922 If the pharmacist recently consulted with the prescriber and has up-to-date clinical information (e.g., Prescription Drug Monitoring Program (PDMP) system or other records), we don’t expect additional consultation with the prescriber. Prescriber consultation: Enter HD-M0-1G.(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

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