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Filing a MAC appeal with OptumRx
The easiest of the large PBMs to file with in volume, because the bulk upload is an official supported path rather than a workaround.
- How you file
Upload an Excel file in the Optum portal at business.optum.com. You can enter as many appeals as needed below row 13, so a month of claims goes in one file.
- Bulk filing
- Yes. Unlimited rows in one spreadsheet.
- What they ask for
- BIN
- NCPDP
- Rx number
- Fill date
- Reason for review
- NDC
- Acquisition cost — required in AR, DE, FL, ID, IN, IA, LA, MS, NC, OK, TN and WA
- New Mexico also wants net purchase price, total reimbursement, drug name and strength
- Filing deadline
- Within 30 days of the claim fill date, or whatever period your state law requires — whichever governs.
- Their turnaround
- Seven business days in Tennessee. Not stated generally.
MAC@optum.com- Portal
business.optum.com- Plan names that route here
- OptumRx · Serve You Rx · Slate Rx (Optum-processed) · Tmesys
Before you file
The deadline that binds OptumRx is usually your state's, not theirs — and in most states the clock starts earlier than people assume. Work out your date, then check what your state requires them to disclose when they deny it.
What owners report about OptumRx
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Add what happened to you
Response metadata only — how long they took and what came back. Never prices, never a MAC list. It takes about two minutes and it is the only way this becomes public.