Get Optum Rx Prior Auth Form

This guide provides a clear and user-friendly approach to completing the Optum Rx Prior Auth Form online. By following these steps, you will ensure that all required information is accurately submitted for the prior authorization request.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin with the member information section. Enter the member's name, insurance ID number, date of birth, and contact details including phone number, and address.
3. Fill in the provider information. Include the provider's name, NPI number, specialty, office address, and contact information.
4. Proceed to the medication information section. Enter the medication name, strength, dosage form, and directions for use. Indicate whether this medication is a new start.
5. In the clinical information section, select the appropriate diagnosis from the provided options. Include any ICD-9/10 codes if applicable.
6. Acknowledge the risk for patients aged 65 and over by selecting 'Yes' or 'No'. Confirm if no other drug can meet the patient's needs.
7. For specific conditions like postmenopausal osteoporosis or vasomotor symptoms, indicate any failures, contraindications, or intolerances to listed medications.
8. Provide any additional comments, diagnoses, or relevant information the physician believes is crucial for the review.
9. Once all fields are completed accurately, save your changes. You may then download, print, or share the form as needed.

Begin the process of completing the Optum Rx Prior Auth Form online today.