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Get Om & Prior Authorization Request Form ... - Optumrx
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How to use or fill out the Om & Prior Authorization Request Form - OptumRx online
This guide provides step-by-step instructions on how to accurately complete the Om & Prior Authorization Request Form from OptumRx. Properly filling out this form ensures timely processing of your request and helps avoid potential delays in obtaining necessary medications.
Follow the steps to fill out the form online:
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter the member information in the required fields, including the member’s name, date of birth, and insurance ID number.
- Provide the provider information, including the provider's name, NPI number, office phone, and address.
- In the medication information section, fill in the medication name, strength, and indicate whether this is a new start.
- Specify directions for use and select the appropriate diagnosis from the provided options.
- List any previous medications the member has failed, had contraindications, or intolerances to.
- If requesting a quantity limit, state the quantity requested per month and the reason for exceeding plan limitations.
- Include any additional comments, diagnoses, symptoms, or important information for the review.
- After completing all sections, review the form for accuracy, then save any changes or prepare to print or share the document.
Complete the Om & Prior Authorization Request Form online for a smoother request process.
The prior authorization process gives your health insurance company a chance to review how necessary a certain medication may be in treating your medical condition. ... During their review the insurance company may decide a generic or another lower cost alternative may work equally well in treating your medical condition.
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