Optum Rx Appeal Submission Guide

Watch the video. 

• Click ‘Open Portal’ on the opportunity in Pharmacy Marketplace

• ‘Sign in’ drop-down in the top right of the page

  • Optum Rx PBM (will open new window to One Healthcare ID log in)

• Log in using your One Healthcare ID

• Optum Rx Pharmacy Portal

• Select MAC Appeal in the top banner (if this is not listed, call Optum Rx help desk). MAC Appeal page (keep this page open as you will upload the document here)

• Select ‘View Submission Guide and Download Appeals Form’ (the blue link)

  • A new window will open

• Download the ‘MAC Appeal Form’ (button in the middle of the page)

  • This will give you a blank Excel form

• Completing the MAC Appeal Form Excel

• Copy and paste information listed on the opportunity in Pharmacy Marketplace ○ Pharmacies only need to submit the information given (not all columns on the Excel form have to be completed).

  • Everything is formatted correctly except the RX number. Pharmacies will need to add preceding zeros to make the value 12 digits.

• Pharmacies can add multiple appeals on a single Excel form.

  • Best practice: Input all the appeal information before submitting the appeal on Pharmacy Marketplace. This will allow you to move through the appeals quickly, then go back and upload the submitted Excel form to each opportunity in Pharmacy Marketplace.

• Submitting Completed Form

• Go back to the Optum Rx MAC Appeal page

• Upload the completed Excel form

  • Uploaded Files will show below

• ‘Submit File’

  Appeal successfully submitted through the PBM portal

  Optum does not give a confirmation number/appeal ID.

• Upload the submitted Excel form to each opportunity in Pharmacy Marketplace. Update opportunity “APPEAL SUBMITTED"

  Appeal was successfully updated through Pharmacy Marketplace.