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Get -oxford Prior Authorization Request Form Member ... - Optumrx
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How to fill out the Oxford Prior Authorization Request Form Member online - OptumRx
Filling out the Oxford Prior Authorization Request Form online is a crucial step in obtaining necessary medication coverage. This guide will provide you with a comprehensive overview of the form and detailed instructions on how to complete each section effectively.
Follow the steps to fill out the form accurately.
- Press the ‘Get Form’ button to obtain the form and open it in your editing tool.
- Complete the Member Information section by entering the required details such as Member Name, Insurance ID number, and Date of Birth.
- Provide the Provider Information, including the Provider Name, NPI number, Office Phone, and Office Address.
- Fill in the Medication Information section with the Medication Name, Strength, and Directions for Use. Indicate whether this is a continuation of therapy.
- In the Clinical Information section, select the requested drug and diagnosis. Include any medication history relevant to the request.
- If applicable, answer the therapeutic failure questions regarding previous medications, specifying the duration of any trials.
- Provide any additional comments or information that may support your request in the relevant section.
- Review all entered information for accuracy. Once confirmed, save any changes, and then download, print, or share the completed form as necessary.
Start completing your document online to ensure a smooth prior authorization process.
Providers can submit their requests to the OptumRx® prior authorization department by completing the applicable form (Part D, UnitedHealthcare or OptumRx) and faxing it to 1-800-527-0531. For urgent requests, call 1-800-711-4555.
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