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  • Optumrx Prior Authorization Form Printable

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Ng or using information in this document is against the law. If you are not the intended recipient, please notify the sender immediately and return the document(s) by mail to OptumRx Privacy Office, 17900 Von Karman, M/S CA016-0101, Irvine, CA 92614. www.optumrx.com Office use only: Comm 2014Apr.doc.

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Contact support

Call HealthSelectSM PDP customer service at Optum Rx toll-free at 1-855-828-9834 (TTY: 711). What do I do if my medication needs a PA? To begin the PA process, you can: • Let your doctor know that a PA is needed for your medication. Call Optum Rx toll-free at 1-855-828-9834 (TTY: 711).

Optum Rx Prior Authorization Guidelines The ePA solution supports all forms of PA and formulary exception requests. Exclusions may include cost reduction requests such as tiering exception, copay waiver, and tier cost sharing. To submit these requests, please contact our PA department at 1-800-711-4555.

Check the status of your PA by signing into optumrx.com > Benefits and claims > Prior authorization or exception request. You will see the status of any active PAs in process. If your medication is approved, the PA is entered and coverage will be provided under your benefit.

Please have the doctor or a qualified member of the office staff complete the next page(s) and fax the completed form to 1-844-403-1024. If you have questions or want to speak with an Optum Rx Prior Authorization Advocate, call 1-800-711-4555.

Submitting a PA request to OptumRx via phone or fax above. For urgent requests, please call us at 1-800-711-4555. (Hours: 5am PST to 10pm PST, Monday through Friday.)

Assuming you're using a medical provider who participates in your health plan's network, the medical provider's office will make the prior authorization request and work with your insurer to get approval, including handling a possible need to appeal a denial.

The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider. As mentioned in the “How does prior authorization work?” section above, this will then often prompt a time-consuming back and forth between the provider and payer.

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© Copyright 1997-2025
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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