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ARTICLE Real-Time Self-Serve Prior Authorization

Some prescription drugs require pre-approval from a patient's health insurance plan before the pharmacy can fill them. This process, called prior authorization, has traditionally been done by phone and by fax – a cumbersome and time-consuming procedure for doctors, patients and pharmacists. No more.


The Real-Time Self-Serve program from OptumRx™ makes the process of accessing needed medications faster and more efficient, all the while ensuring appropriate safety checks and balances. This capability resides in a new online channel for prior authorizations that integrates plan, member and physician data that's available 24 hours a day. Prescription Solutions is the only major Pharmacy Benefits Management firm offering this service.


Linked systems


Real-Time Self-Serve lets our Claims and Prior Authorization systems 'talk' to each other for the first time. So now physicians can submit information electronically that previously had to be collected manually.


Sixty percent of the time physicians receive an instant approval. If required, a further clinical review typically can be completed in less than 72 hours. Also, physicians and health care professionals can use the new service to check on the status of a Prior Authorization request, even if it was not submitted online.


The Real-Time Self-Serve program is helping to make health care simpler, more consistent and more responsive for our members. Meanwhile, physicians and other health care providers can spend less time on routine administration and more time with their patients.


Status: Real-Time Self-Serve is currently available to registered health care providers.