Get Optumrx Prior Authorization Form

Filling out the Optumrx Prior Authorization Form can seem daunting, but it is a straightforward process when approached step by step. This guide aims to assist users in completing the form accurately online to ensure timely approval for necessary medications.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the Optumrx Prior Authorization Form and open it in a text editor.
2. Begin by entering the patient information. Fill in the patient's name, insurance ID, date of birth, height, weight, and contact information. Ensure that you provide the complete address including apartment number, city, state, and zip code.
3. Proceed to the provider information section. Enter the provider's name, provider ID number, address, city, phone number, and fax number. Document the provider's specialty to ensure accurate processing.
4. In the medication information section, clearly state the medication name, quantity needed, ICD-9 code, directions for use, diagnosis, and refills requested. Do not forget to add the physician's signature where indicated and indicate if the physician will supply the medication.
5. Continue to the medication instructions. Indicate whether the patient has been instructed on how to self-administer the medication, if this is a new start, and provide the initiation date if relevant.
6. Fill in the delivery instructions. Specify where the medication should be shipped and the needed date. Check the appropriate options regarding medication administration (e.g., home health, self-administered, etc.).
7. Review the entire form for accuracy and completeness. Check if any clinical information needs to be attached to support the diagnosis or previous treatments. Make sure all fields are filled out as required.
8. Once all information is entered and verified, save the changes to your document. You may now download, print, or share the completed form as needed for submission.

Complete your documents online for efficient processing and quicker approvals.