IL 2739-FFS: Iowa Medicaid Pharmacy Program Changes: PBA Transition to Optum Rx

By July 27, 2026, 7:00 PM CST: (1) Billing team must prepare for the 3-hour system blackout (8:00 PM – 11:00 PM CST). Queue any non-urgent claims for submission after 11:00 PM CST when Optum Rx systems are live. (2) Update internal documentation to reflect that BIN 011933 and PCN IAPOP remain the same for Optum Rx. (3) Update contact information in pharmacy systems: continue using helpdesk 877-463-7671 or 515-256-4608, and direct future PAs to fax 800-574-2515 or submit electronically. (4) Prior Authorization Coordinators: any PA requests received after 2:00 PM CST on 7/27/26 must be resubmitted after 8:00 AM CST on 7/28/26 in the new Optum Rx system. (5) Billing team must immediately update Coordination of Benefits (COB) procedures: when using Other Coverage Code (OCC) 2, BOTH Other Payer Amount Paid (OPAP) and Other Payer Patient Responsibility (OPPR) are now required. OCC 8 is no longer accepted—audit all templates and claim submission logic. (6) For claims involving members under 21 years of age: billing team must ensure third-party liability (TPL) information is included on all claims if applicable. If no TPL exists, direct members to contact member services at 515-256-4606 or 800-338-8366. (7) Designate staff to monitor for unexpected claim rejections or system issues on 7/27/26 evening and report any problems to pharmacy helpdesk at pba_iapdlinfo@optum.com for expedited resolution. Failure to implement COB and TPL changes will result in claim denials or delays.