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OptumRx. com and click Health Care Professionals OptumRx M/S CA 106-0286 3515 Harbor Blvd. Costa Mesa CA 92626 Prior Authorization Request Form Member Information required Provider Information required Member Name Provider Name Insurance ID NPI Date of Birth Office Phone Street Address Office Fax City State Phone Zip Specialty Office Street Address Medication Information required Medication Name Strength Is This Medication a New Start Yes No Dosage Form Directions for Use Clinical Information required Select the diagnosis below Adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer Hypothyroidism Other diagnosis ICD-9/10 Code s Select the medications the member has a failure contraindication or intolerance to Are there any other comments diagnoses symptoms medications tried or failed and/or any other information the physician feels is important to this review Please note This request may be denied unless all required inf....

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OptumRx and BriovaRx are subsidiaries of UnitedHealth Group. ... Health Plan coverage provided by or through a UnitedHealthcare company.

BriovaRx is changing its name to Optum Specialty Pharmacy and BriovaRx Infusion Services is changing its name to Optum Infusion Pharmacy.

OptumRx and BriovaRx are subsidiaries of UnitedHealth Group. ... Health Plan coverage provided by or through a UnitedHealthcare company.

(March 17, 2016) OptumRx and Walgreens are partnering to create a new pharmacy solution to meet consumers' changing prescription drug needs and help employers, health plans and their members achieve better health outcomes and greater cost savings.

Contact ORxProviderHelp@optum.com or call 1-800-791-7658. Send us a complete prescription using the Physician Fax Form. Questions? Provide a verbal prescription directly to an OptumRx pharmacist dedicated to our health care providers.

Contact your doctor for a new prescription. Have your doctor complete the enclosed Fax Order Form and fax it back to the number listed on the form. Or, when you transition to OptumRx, you can call the phone number on the back of your ID card and they will work directly with your doctor to obtain your medication(s).

Mail this completed order form with your new prescription(s) to OptumRx, P.O. Box 2975, Mission, KS 66201.

Pharmacies can only dispense Schedule III, IV, and V controlled substances with a written, oral, or faxed prescription. ... Oral and faxed prescriptions must contain all the required elements except the signatory approval.

Optumrx has a consumer rating of 1.14 stars from 119 reviews indicating that most customers are generally dissatisfied with their purchases. Consumers complaining about Optumrx most frequently mention customer service, day supply and insurance company problems. Optumrx ranks 45th among Pharmacy sites.

OptumRx is an affiliate of UnitedHealthcare Insurance Company.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232