JSON twin: https://www.healthaidb.com/software/optum-prior-authorization.json
Optum
https://business.optum.com/en/pharmacy-services/electronic-prior-authorization.html
Optum Prior Authorization is an enterprise prior-authorization solution (including ePA and APIs) that automates submission, status inquiry and utilization management workflows to speed approvals and reduce manual work for providers, pharmacies and payers.
Optum Prior Authorization (Optum/OptumRx) provides electronic prior authorization (ePA), prior-authorization inquiry APIs, portals and workflow services that integrate with EHRs, pharmacy systems and payer systems to submit requests, check authorization status in real time, manage appeals/reauthorizations, and reduce turnaround time and denials. The offering supports provider and pharmacy portals, payer-side utilization management, specialty pharmacy workflows and integrations with third-party ePA vendors (eg, CoverMyMeds) and EDI/web endpoints.
unknown
2011
P1207
2025-09-07
proprietary
Enterprise pricing; contact Optum/UnitedHealth Group for quotes and implementation details. Some ePA integrations available via partners (may have separate fees).
enterprise_quote
product
1.0
{
"company_name": "Optum",
"company_url": "https://www.optum.com",
"company_offices": [
"United States",
"United Kingdom",
"India",
"Ireland",
"Costa Rica",
"Philippines",
"Canada",
"Germany"
],
"company_founding": "2011",
"product_url": "https://business.optum.com/en/pharmacy-services/electronic-prior-authorization.html",
"categories": [
"administrative",
"utilization management",
"pharmacy",
"prior authorization",
"payer tools",
"APIs"
],
"market_segment": [
"enterprise"
],
"links": [
"https://www.optum.com",
"https://business.optum.com/en/pharmacy-services/electronic-prior-authorization.html",
"https://marketplace.optum.com/products/eligibility_and_claims/Prior-Authorization-Inquiry-API.html",
"https://business.optum.com/en/insights/automating-prior-authorization-process.html",
"https://business.optum.com/en/support/professionalrx-resources/pa-guidelines-procedures.html",
"https://www.unitedhealthgroup.com/newsroom/posts/2024/2024-10-22-optumrx-prior-authorization-process-to-improve.html",
"https://www.covermymeds.health/prior-authorization-forms/optumrx",
"https://public.providerexpress.com/content/ope-provexpr/us/en/about-us/prior-authorization-of-service.html",
"https://www.healthcaredive.com/news/optum-rx-eliminate-prior-authorizations/742910/"
],
"summary": "Optum Prior Authorization is an enterprise prior-authorization solution (including ePA and APIs) that automates submission, status inquiry and utilization management workflows to speed approvals and reduce manual work for providers, pharmacies and payers.",
"description": "Optum Prior Authorization (Optum/OptumRx) provides electronic prior authorization (ePA), prior-authorization inquiry APIs, portals and workflow services that integrate with EHRs, pharmacy systems and payer systems to submit requests, check authorization status in real time, manage appeals/reauthorizations, and reduce turnaround time and denials. The offering supports provider and pharmacy portals, payer-side utilization management, specialty pharmacy workflows and integrations with third-party ePA vendors (eg, CoverMyMeds) and EDI/web endpoints.",
"target_users": [
"clinicians",
"pharmacists",
"providers (office staff)",
"nurses",
"health system administrators",
"payer/utilization management staff",
"specialty pharmacy operators",
"IT/interop teams"
],
"specialties": [
"pharmacy/medication management",
"specialty pharmacy",
"behavioral health",
"oncology",
"endocrinology/diabetes management",
"ambulatory care"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Enterprise pricing; contact Optum/UnitedHealth Group for quotes and implementation details. Some ePA integrations available via partners (may have separate fees).",
"license": "proprietary",
"deployment_model": [
"SaaS"
],
"os_platforms": [
"Web"
],
"features": [
"Electronic prior authorization submission (e-PA)",
"Initiate PA from provider portals",
"Attach/upload chart notes (JPEG, TIFF, PDF)",
"Plan-specific clinical question workflow",
"Case resolution notifications (approve/deny/follow-up)",
"Verbal prior authorization option (phone)",
"Support for Medicare/state-specific/forms workflow",
"Integration with third-party e-PA portals"
],
"optional_modules": [],
"integrations": [
"CoverMyMeds",
"Surescripts",
"PreCheck MyScript",
"DrFirst",
"CenterX",
"Allscripts",
"Optum Home Delivery",
"Optum Specialty Pharmacy",
"Optum Infusion Pharmacy"
],
"data_standards": [
"NCPDP"
],
"api_available": "unknown",
"system_requirements": "",
"compliance": [],
"certifications": [],
"security_features": [
"Secure upload with encryption",
"Secure transmission using NCPDP standard"
],
"privacy_features": [
"Secure chart note upload"
],
"data_residency": "",
"customers": [
"UnitedHealthcare"
],
"user_reviews": [
"They give a pretty high goal of 60 cases completed a day and as a new hire that felt intense.",
"Very metric heavy — when volume slowed people were cut before contract end.",
"Work from home PA pharmacist — good work/life balance and pay but contract-to-perm conversion is low.",
"e-PA produced faster determinations compared with phone/fax in our workflow; saved significant admin time."
],
"ratings": [
"Glassdoor 3.5/5 (Prior Authorization Technician reviews)",
"TrustRadius listings and reviews present (product page reviews exist)"
],
"support_channels": [
"phone (1-800-711-4555)",
"e-PA portals (CoverMyMeds, Surescripts, PreCheck MyScript, DrFirst, CenterX, Allscripts)",
"support resources/forms (downloadable PA forms)",
"online documentation"
],
"training_options": [
"documentation",
"video tutorials",
"webinars",
"live_online"
],
"release_year": "",
"integration_partners": [
"CoverMyMeds",
"Surescripts",
"PreCheck MyScript",
"DrFirst",
"CenterX",
"Allscripts"
],
"id": "P1207",
"slug": "optum-prior-authorization",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/optum-prior-authorization.json"
}
}