Streamline pharmacy adjudication and operations
Our pharmacy adjudication solutions help speed claims to payers, validate claims accuracy, confirm patient eligibility and offer copay assistance. It's all designed to help enhance the adjudication process, claims management and payment cycles.
What's included
Rx Connect™
A claims-switch pharmacy adjudication network
- Allows pharmacies to send claims to any U.S. third-party processor
- Works within existing pharmacy workflows
Rx Edit
A comprehensive pharmacy claim solution
- Designed to increase third-party reimbursements
- Helps improve in-store productivity
Rx CardFinder™ Services
A pharmacy eligibility service
- Checks member coverage with the nation’s largest pharmacy benefits manager (PBM)
- Get returns with real-time responses
Rx Assist
A dynamic copay assistance and messaging platform
- Delivers prescription savings and educational messaging to patients at the point of service
- Helps drive increased brand loyalty and medication adherence
Key benefits
Choose pharmacy management tools that work for you.
Pharmacist-developed solutions to enhance accuracy and patient safety
Software designed by pharmacists and technicians is continuously enhanced by the nation's largest pharmacy-focused development team.
An enterprise pharmacy system to help improve customer satisfaction
Optimize customer satisfaction with outbound notifications, medication synchronization, remote prescription counseling and mail-order services.
Pharmacy Network FAQ
A pharmacy network is a contracted group of pharmacies that dispense covered meds at negotiated rates — often helping lower member costs. Optum pharmacy networks help balance access, cost and quality.
Real-time claims adjudication screens and prices a claim in seconds, returning approve/deny or next steps. Optum supports this with Rx Connect™ (claims switch) and Rx Edit (claim edits) to help reduce rework.
Pharmacies send electronic eligibility checks to confirm active benefits and cost share before dispensing. Rx Connect™ and standard 270/271 transactions help cut surprises and denials.
Typical reasons include:
- Bad member data
- Refill‑too‑soon
- Out‑of‑network
- Missing prior authorization
Use eligibility checks to flag issues early. Rx CardFinder™ can surface savings messages at point of sale.
Prior authorization confirms a drug meets plan rules before coverage. To help speed decisions and reduce callbacks, use electronic prior authorization or e-PA. Include complete clinical details and act on PA flags.
Data standards that Optum solutions align to include:
- NCPDP Telecommunication (runs point-of-sale claims)
- X12 270/271 (handles eligibility)
- NCPDP SCRIPT (powers e‑prescribing)
Industry insights
White paper
Transform claims with AI and API integration to reduce denials, strengthen transparency and drive more efficient, intelligent operations.
Fact sheet
Integrate PGx data into pharmacy claims to support safer prescribing, smarter medication management and better patient outcomes.
Article
Enable more effective and targeted treatments that address unique needs for patients with pharmacogenomics.