OptumRx - Clinical Updates

Effective January 1, 2018

Author: Erica Lawrence/Friday, December 15, 2017/Categories: APCI Choice

Effective January 1, 2018, OptumRx will be enabling an enhanced prescriber DEA license scope of practice check at point of sale for all Schedule II-V controlled medication claims to prevent payment of scheduled medication claims from unauthorized prescribers.

This scope of practice check will validate submission of a valid, non-expired DEA prescriber license and then match the submitted prescriber’s full two alphabetic letters and 7 digit numeric license number string to the submitted controlled drug GPI. Successful validation of these two steps will allow the claim to proceed to adjudication. However, failure of the check will result in a hard reject at point of sale for any of the following reasons:

*Please see attachment for more information.

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