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Get Optumrx Prior Authorization Form
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How to fill out the Optumrx Prior Authorization Form online
Filling out the Optumrx Prior Authorization Form online is an essential step for obtaining necessary medications. This guide provides clear, step-by-step instructions to ensure a smooth process for users of all experience levels.
Follow the steps to complete the form accurately and efficiently.
- Press the ‘Get Form’ button to access the Optumrx Prior Authorization Form and open it in your document editor.
- Begin by entering the member information. You will need to provide the member's name, insurance ID number, and date of birth. Ensure that these details are accurate.
- Next, fill out the provider information section. Include the provider's name, NPI number, office phone number, street address, and any other relevant contact information.
- In the medication information section, specify the medication name, strength, dosage form, and directions for use. Indicate whether this medication is a new start.
- Provide the clinical information by selecting the diagnosis from the listed options. If applicable, include any relevant ICD-9/10 codes.
- List any medications the member has previously tried that were ineffective or caused adverse reactions, maintaining accuracy in the selections.
- If a quantity limit exceeds the plan's restrictions, indicate the quantity requested per day and provide a reason for this request.
- Finally, review the comments section to include any additional information, diagnoses, or past treatments pertinent to this request.
- Once all fields are completed, you can save changes, download a copy of the form, print it for records, or share as necessary.
Complete your forms online to ensure a timely response and care.
To obtain prior authorization, call the number on your ID card. This call starts the utilization review process.
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