Reduced pharmacy costs for a better healthcare system
Web services
Third-party web services
The system allows a third-party vendor to intercede on the transaction within the pharmacy claims adjudication process. These interventions are allowed during pre- and post-adjudication.
Reroute transactions
Suspend and reroute transactions
Third-party vendors can intervene on a transaction initially submitted by a pharmacy by suspending the transaction and submitting a rerouted transaction in its place based on obtaining a better price for the patient.
Intelligent routing
Processor intelligent routing
The intelligent system allows a third-party vendor to take action on a transaction without directly receiving the request. In this instance, the vendor shares with Optum their routing rules and Optum PPE makes the update to the BIN/PCN on the transaction.
Save time
Save time and resources
Incorporating complex routing logic directly into the claims processing workflow automates manual processes for pharmacies, reduces unnecessary expenditures and saves time and resources.
Key benefits
Simplify pharmacy claims routing
- Increase medication adherence.
- Reduce out-of-pocket price for patients.
- Automate manual processes.
- Reduce health plan and expenditures.
- Enrich the patient experience.
- Simplify the pharmacy claims routing system.
Intelligent claims processing
- Obtain lowest prescription pricing.
- Benefit from efficient third-party web service.
- Suspend and reroute claims submissions.
- Save time and resources.
Industry insights
Video
Real-time insights and unified data are helping organizations reduce unnecessary utilization, close care gaps and improve patient outcomes.
Article
Leading payers are implementing strategies that expand access, simplify navigation and connect members to the right behavioral health support at the right time.
Case study
How Optum helped a health system consolidate over 40,000 charges.
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Rx Edit
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Rx Connect™
Our claims switch adjudication network allows pharmacies to send claims in real time to any U.S. third-party processor.