Temporary Payment Advance Program for Optum Rx Network Pharmacy Partners
Throughout the Change Healthcare outage, maintaining continuity of care for patients has been our top priority. Optum Rx has committed to reimbursing appropriate prescriptions filled in good faith by our pharmacy network partners. We recognize that the disruption caused by the Change Health Care outage may be creating cash flow challenges for independent pharmacies. To help our pharmacy partners during these extraordinary circumstances, Optum Rx has created a limited duration cash advance process to support independent pharmacies in the Optum Rx Network. There are no fees or interest charged on cash advances. Optum Rx network pharmacies may request an advance payment of funds based on prescriptions they have filled and provided to Optum Rx members where the pharmacy is experiencing cash flow problems due to dispensing those prescriptions. Pharmacies seeking a payment advance must request it through the Optum Rx Pharmacy Help Desk at 1-800-788-7871.
To qualify:
- Must be an Optum Rx Network pharmacy serving Optum Rx patients who need a cash advance (excludes chains). Advance is per pharmacy.
- Must be in good standing with Optum Rx – no audits, terminations, audit suspension, suspected FWA.
- May request between $10,000 - $100,000 based on prescriptions filled and dispensed 2/21/24 or later where there was a delay in the pharmacy’s ability to submit claims for Optum Rx members.
- Must attest that the prescriptions have been dispensed.
- Must submit information at the pharmacy level: NPI, NCPDP number, pharmacy name and list the following Optum Rx member claim information: BIN, PCN, Group ID, Member ID, Date of Service, Rx Number, NDC, Quantity Dispensed, Submitted Cost
- May request payment advance no more than one time per week.
- Will be required to sign an agreement to return funds to Optum Rx at a later date.