Get Optumrx Ncpdp Version D.0 Payer Sheet ***commercial And ...

This guide provides a clear and detailed overview of how to complete the OptumRx NCPDP Version D.0 Payer Sheet. Each section and field is outlined step-by-step to assist users in accurately filling out the form online.

Follow the steps to complete the OptumRx NCPDP Version D.0 Payer Sheet.

1. Click the ‘Get Form’ button to obtain the OptumRx NCPDP Version D.0 Payer Sheet and open it in your preferred editor.
2. Fill out the Payer Name section, ensuring to include 'OptumRx' and specify if it applies to 'Commercial and Medicaid'.
3. Enter the relevant Date for the form, typically the date you are filling out the sheet, in the format MM/DD/YY.
4. Input the BIN numbers provided such as 610494, 015243, and others, ensuring each is accurately recorded.
5. Complete the PCN section by entering the processor control numbers (PCN) as specified, ensuring accuracy for processing.
6. Add the required identifiers in the Transaction Header Segment, including the transaction code, which defines the type of claim being submitted.
7. In the Insurance Segment, fill out necessary information for the cardholder, including their ID and relationship codes.
8. Proceed to the Patient Segment and provide essential details like patient ID, date of birth, and contact information.
9. In the Claim Segment, specify the nature of the claim, ensuring all billing information including prescription references are noted.
10. Finally, review all inputs for accuracy before saving changes. You may then download, print, or share the completed form as required.

Start completing your documents online for efficient management and submission.