Select Rx Customer Service: Expert Operational Guide

Overview and scope of Select Rx customer service

Select Rx customer service acts as the operational interface between beneficiaries, prescribers, pharmacies and the pharmacy benefit manager (PBM) platform. Its responsibilities typically include claims adjudication, formulary and tier information, prior authorization (PA) management, specialty pharmacy coordination, member cost-share calculations, and handling appeals. Professionals working with Select Rx should expect direct interactions across clinical, technical and member relations teams and prepare for both real-time phone support and asynchronous electronic workflows.

Most mature PBM customer service operations maintain separate tracks: member services (benefit/coverage questions), provider/pharmacy services (claims, adjudication, billing), and clinical review (PA, step therapy, DUR). Response methods include live phone lines, secure web portals, ePA (electronic prior authorization) through industry gateways like Surescripts/NCPDP SCRIPT, secure fax, and email for non-sensitive items. Confirm the official contact channels using the back of the member’s insurance card or the health plan’s website to avoid fraud.

How to prepare before contacting Select Rx customer service

Preparation reduces call time and improves resolution rates. Always have the member ID, group number, Rx or NDC, date of service, claim reference (if available), prescriber NPI, pharmacy NPI, and the specific error or denial code shown on the pharmacy system. If the issue is a PA or clinical exception, prepare a succinct timeline of prior therapy (drug names, dosages, treatment dates) and attach supporting clinical notes or lab results when submitting documentation.

For pharmacies, bring transaction details: BIN, PCN, Group, Processor Control Number (if present), the exact NCPDP response code and the refill date allowance or quantity metric in question. When possible, use the secure provider portal to upload charts or use the ePA channel to transmit prior authorization requests — ePA typically reduces decision time from days to hours when both PBM and prescriber systems support it.

Common issues and step-by-step resolutions

Claims denied for incorrect member information: verify member ID, DOB and effective date first. If data mismatch is found, correct and resubmit the claim electronically. For coordination of benefits (COB) issues, identify primary vs secondary payers, obtain primary EOB copies and submit them directly through the claims appeal channel or the secure provider portal; expect adjudication after COB review, often within 7–14 business days depending on plan rules.

Prior authorization denials and step therapy failures are common. Ask customer service for the precise denial rationale, required clinical criteria, and whether an expedited (urgent) review is available. Prepare a medical necessity letter with targeted references (guideline citations, prior therapy failures) and submit via ePA or secure fax; urgent requests are typically adjudicated within 72 hours where the plan’s policy allows, while standard reviews may take up to 14–30 calendar days depending on the plan.

Escalations, appeals, and regulatory timelines

Understand the escalation ladder: Tier 1 (front-line agent), Tier 2 (senior pharmacy or claims analyst), Clinical Review (pharmacist or nurse reviewer), and Appeals/Grievance Department. Note that many plans require an internal appeal step before an external review. Document each call (date, time, agent ID, and confirmation number) and request written confirmation of outcomes for audit trails. If internal appeals are unsuccessful, members may have access to external independent review organizations (IROs) under state insurance regulation.

Timelines vary by contract and jurisdiction. Typical internal appeal windows range from 30 to 180 days from the adverse determination; urgent appeals are often processed within 72 hours. If the member is eligible for beneficiary protections (e.g., Medicaid/Medicare supplemental rules), specialized timelines and patient notices apply — confirm the plan’s member handbook or state insurance commission guidance for exact deadlines.

Best practices for pharmacies and prescribers working with Select Rx

Operational discipline reduces errors: keep real-time formulary access (via PBM portal or integrated EHR/dispensing software), document each transaction, and use electronic prior authorization and e-prescribing wherever available. For specialty medications, connect with the PBM’s specialty pharmacy team early — they often coordinate benefits, financial assistance, and case management and can provide clear benefit cost estimates and ship-to settings (retail vs direct specialty ship).

Maintain a “single source of truth” for records. Consolidate EOBs, PA approvals, and appeal correspondence into the patient’s chart and include the PBM case number on subsequent inquiries. For recurring problems (e.g., systemic reject codes) track frequency and escalate directly to account management or provider relations; these teams can raise system-level fixes such as payer file updates or formulary tier corrections.

Checklist before calling Select Rx customer service

• Member details: name, DOB, member ID, group number, effective date; EOB or claim reference if available.
• Transaction specifics: Rx number, NDC, prescribing NPI, pharmacy NPI, BIN/PCN, transaction timestamp and exact rejection text.
• Clinical support: prior medication list, labs/diagnostics, rationale for medical necessity, and copies of previous PAs or denials.
• Technical evidence: screenshot of pharmacy system error, NCPDP response code, and any claim trace IDs to speed technician lookup.

Escalation outline and quick call script

• Start: “Hello, my name is [Name], I’m calling on behalf of [Member name] with member ID [ID]. The issue is a claim denial for [drug/NDC] on [date]. My claim/trace number is [X]. Can you confirm the denial reason and available remedies?”
• If Tier 1 cannot resolve: Request escalation to “claims analyst” or “clinical review.” Ask for an estimated callback window and a confirmation number. Record agent name/ID and time.
• For urgent clinical cases: state “This is an urgent medical exception; the prescriber requests an expedited review due to [brief clinical rationale]. Please route this to clinical pharmacy review and provide the escalation reference number.”

What is the number for 1 800 807 5996?

Sample Prescription Drug ID Card
If you have a question about your pharmacy benefits or need to locate a nearby participating pharmacy, please call the OptumRx Member Services Department at 1-800-807-5996 (TTY 1-888-411-0767), 24 hours a day, seven days a week.

Is SelectRx legitimate?

SelectRx is one of the leading prescription delivery services due to its integrated customer service that helps make getting medications quick, easy and stress-free. Pros: Pharmacists check in monthly and are diligent about making sure customers’ boxes are up-to-date and accurate.

Is simple meds the same as SelectRx?

Express Med and Simple Meds Now Part of SelectRx
Express Med Pharmacy Services and Simple Meds were both acquired by SelectRx in 2021.

Can I get zepbound through mail order pharmacy?

Zepbound® self-pay options
No insurance needed. *Special offer pricing for first fills and refills is only available through LillyDirect’s mail-order pharmacy, and you must make these within 45 days of the previous delivery.

Is SelectRx a mail order pharmacy?

Although we deliver prescriptions by mail, SelectRx is accredited as a Patient-Centered Pharmacy Home–We are a medication management program that provides patient-centered pharmacy care at home with long-term care pharmacy services.

How does SelectRx work?

How It Works. Start with our simple form to share your interest in working with SelectRx. Once we have all the info we need, you can take a deep breath. We’ll have your personalized monthly box and medication packets delivered right to your door and you never have to worry about calling for a refill.