OPTUMRx Pharmacy Provider Credentialing Application
This application is necessary to assess the qualifications of pharmacies for participation in the network. It includes information on pharmacy operations, accreditation, and contact details. Completing this application accurately ensures compliance with regulatory requirements.
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How do I fill this out?
Filling out the OPTUMRx Pharmacy Provider Credentialing Application involves several key steps. Begin by gathering all necessary documentation and information. Ensure that each section is completed thoroughly to avoid delays in processing.
How to fill out the OPTUMRx Pharmacy Provider Credentialing Application?
1
Gather the required documentation including licenses and certifications.
2
Complete all sections of the application accurately.
3
Double-check all entries for completeness and correctness.
4
Submit the application along with supporting documents.
5
Follow up to confirm receipt and address any additional requirements.
Who needs the OPTUMRx Pharmacy Provider Credentialing Application?
1
Pharmacy owners who are starting a new location need this application to establish a contractual relationship.
2
Organizations requiring pharmacy services for their members need to verify pharmacy qualifications through this credentialing process.
3
Healthcare providers seeking partnerships with pharmacies need to ensure compliance and credentialing for patient safety.
4
Regulatory bodies may need this file to ensure pharmacies meet operational and accreditation standards.
5
Existing pharmacies undergoing changes in ownership should fill out this application to maintain their network affiliations.
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What are the instructions for submitting this form?
To submit this form, please provide your completed application along with all required documentation to the specified email address or fax number provided on the form. Ensure you keep a copy for your records. For physical submissions, send to the address indicated at the top of the application. Doubling checking all information before submitting will help avoid delays.
What are the important dates for this form in 2024 and 2025?
Please be aware that submission deadlines for this application may vary based on your state regulations and pharmacy affiliations. It is advisable to check for compliance dates regularly. Make timely submissions by keeping track of the start and renewal dates specific to your pharmacy needs.
What is the purpose of this form?
The purpose of the OPTUMRx Pharmacy Provider Credentialing Application is to facilitate the thorough evaluation of pharmacy qualifications for participation in healthcare networks. It helps ensure pharmacies meet all necessary standards and regulations in the industry. By adhering to this process, pharmacies can maintain compliance and provide quality service to their customers.
Tell me about this form and its components and fields line-by-line.
- 1. NCPDP #: National Council for Prescription Drug Programs number identifies the pharmacy for electronic claims.
- 2. NPI #: National Provider Identifier number for billing and identification purposes.
- 3. Pharmacy DBA Name: Doing Business As name that the pharmacy operates under.
- 4. Pharmacy Legal/Corporate Name: The official registered name of the pharmacy entity.
- 5. Date Acquired: The date the pharmacy changed ownership, if applicable.
- 6. Store #: Internal identification number for the pharmacy location.
- 7. Date Opened: The date when the pharmacy began operations.
- 8. Effective Chain/PSAO affiliation Date: Date when the pharmacy joined a Pharmacy Services Administrative Organization.
- 9. Franchise Name: If applicable, the name of the franchise under which the pharmacy operates.
What happens if I fail to submit this form?
Failure to submit this form can result in delays in your pharmacy's ability to participate in necessary networks. It may also lead to non-compliance issues with state regulations and lost business opportunities.
- Regulatory Non-compliance: Failure to meet requirements can lead to penalties and loss of licenses.
- Network Exclusion: Delays in application processing may prevent participation in essential healthcare networks.
- Loss of Business: Inability to provide services under certain contracts due to incomplete applications.
How do I know when to use this form?
- 1. New Pharmacy Applications: For new pharmacies establishing their business in a network.
- 2. Ownership Changes: When a pharmacy changes ownership, this application must be submitted.
- 3. Affiliation Changes: To request a change in affiliation with a PSAO.
- 4. Licensing Updates: For updates related to licensing and regulatory compliance.
- 5. Renewal Processes: When renewing participation in pharmacy networks.
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