Get Optumrx Prior Auth Form

Filling out the Optumrx Prior Auth Form online is an essential process for obtaining prior authorization for medication. This guide provides step-by-step instructions to assist users in completing the form efficiently and accurately.

Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member information, which is required. This includes the member's name, insurance ID number, and date of birth. Ensure that all fields are filled out accurately.
3. Next, input the provider information. Fill in the provider's name, NPI number, office phone, and office fax. Providing accurate details will help in processing the request.
4. Proceed to the medication information section. Enter the medication name, strength, and indicate whether this medication is a new start by selecting ‘Yes’ or ‘No’. Include dosage directions and dosage form.
5. In the clinical information section, select the diagnosis. If the diagnosis is 'Other', provide the specific details and the corresponding ICD-9/10 code. Respond to the risk acknowledgment questions regarding the usage of the drug in individuals aged 65 and over.
6. Document the medications the patient has previously tried, indicating any failures, contraindications, or intolerances by checking the applicable boxes.
7. For quantity limit requests, specify the quantity requested per day and the reason for exceeding plan limitations. Choose from the options provided.
8. Lastly, fill in any additional comments, diagnoses, or relevant information that may aid in the prior authorization review. Review all your entries for accuracy.
9. Once completed, you can save the changes, download, print, or share the form as needed.

Start filling out your document online today for a smooth submission process.