OptumRx Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with OptumRx. Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 72h standard, 24h expedited
- Appeals Address: OptumRx Prior Authorization Appeals, PO Box 25183, Santa Ana, CA 92799
- Provider Portal: https://professionals.optumrx.com/
Why OptumRx Denies Prior Authorizations
- 1. Non-formulary
- 2. Step therapy
- 3. Quantity limit
Clinician Tips for OptumRx
- ✓ OptumRx is UHC PBM
- ✓ BriovaRx/Optum Specialty is the specialty arm
- ✓ Electronic PA via Surescripts or CoverMyMeds
PBM owned by UnitedHealth Group.
OptumRx Prior Authorization FAQ
Why does OptumRx deny prior authorizations?
The most common OptumRx denial reasons are: Non-formulary; Step therapy; Quantity limit.
How long does OptumRx take to review a prior authorization?
OptumRx typically responds in 72h standard, 24h expedited.
What should a Letter of Medical Necessity for OptumRx include?
An LMN for OptumRx should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. PBM owned by UnitedHealth Group.