Link to third-party pharmacy payers
Use our software to access a claims adjudication network for any third-party processor and deploy flexible, on-demand tools to support research, monitoring and service activity tracking.
Rx Connect™ features include:
- High-speed intelligent network built to operate within existing pharmacy workflow
- Security-focused network that supports infrastructure needs
Secure claims routing to U.S. third-party processors
Switch claims
Switch claims in real time
A cloud-based platform improves flexibility, scalability, security and resiliency. Comprehensive services include:
- Claims processing
- Claims editing
- Real-time insurance verification
- E-prescribing
- Medical and vaccination claims billing
Secure network
Operate on a secure network
Meet your specific infrastructure requirements with a variety of security-enabled connectivity options. Accreditation from Healthcare Network Accreditation Program (HNAP) and the Electronic Healthcare Network Accreditation Commission (EHNAC) supports compliance that exceeds industry established standards and HIPAA Privacy Rule regulations.
On-demand tools
Flexible, on-demand tools
Tools offer the ability to research, monitor, track and troubleshoot service activity for maximum efficiency and productivity. Innovative solutions include:
- Targeted messaging
- Electronic copay programs
Rx Connect FAQ
Switches route real‑time NCPDP Telecommunication Standard transaction types such as claim billing/reversals (B1/B2), coordination of benefits and eligibility — the standard rails used by pharmacies and payers.
After primary adjudication, the originating switch forwards approved secondary claim details to the Medicare Part D Transaction Facilitator for TrOOP reporting using composite transactions.
A switch routes your NCPDP transactions to the right payer/PBM and back, providing connectivity services and Medicare Part D support flows, rather than adjudicating benefits itself.
Use Optum’s Rx Professionals Resources and Business Customer Support to access current payer lists, payer sheets and notices for pharmacy claim routing.
Request a sandbox/API and product details via the Optum Marketplace listing for Rx Connect. You can submit a quote request and integration inquiry there.
Optum’s network uses modernized infrastructure, MFA and hardened firewalls to protect high‑volume transactions, built for performance, reliability and security at scale.
Yes. NCPDP Telecommunication Standard guidance supports service (“S”) transactions for pharmacist services. Adoption is payer‑specific, so confirm contracts and payer sheets before use.
F6 introduces expanded data elements and moves toward an 8‑byte IIN on ID cards (replacing 6‑byte BIN in displays), affecting routing and payer sheets.
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