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Get Optumrx & Linzess Prior Authorization Request Form 2015
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How to fill out the OPTUMRx & Linzess Prior Authorization Request Form online
This guide provides clear instructions for completing the OPTUMRx & Linzess Prior Authorization Request Form online. Following these steps will ensure you provide all necessary information for a successful authorization request.
Follow the steps to complete the form efficiently.
- Click 'Get Form' button to obtain the form and open it for editing.
- Enter the member information: Fill in the required fields including the member's name, insurance ID number, date of birth, and address details.
- Input the provider information: Include the provider's name, NPI number, office phone, fax, street address, city, state, and zip code.
- Complete the medication information: State the medication name, strength, dosage form, and check if you are requesting the brand version. Provide directions for use and indicate if it is a continuation of therapy. Answer the following questions regarding the member's medication history.
- Fill in the clinical information: Select the requested drug and the relevant diagnosis from the provided options. Document any medication history related to the prescribed drugs.
- If applicable, provide information for reauthorization requests, confirming the documentation of the positive clinical response.
- Include any additional comments or important information that may assist in the review process.
- Upon completing the form, review all entries for accuracy, then save changes, download, print, or share the form as necessary.
Complete the OPTUMRx & Linzess Prior Authorization Request Form online today for timely processing.
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The fax number for submitting an Optum Rx prior authorization form can vary by medication and your location. Typically, you can find this information on the Optum Rx website or by contacting their customer service. Always double-check to ensure you send the form to the correct number for seamless processing.
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