Get Flexpen Prior Authorization Request Form ... - Optumrx

Filling out the FlexPen Prior Authorization Request Form is essential for securing approval for medication. This guide provides clear, step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to access the form and open it in your chosen interface.
2. In the Member Information section, provide the required details including member name, insurance ID number, date of birth, and contact information. Ensure all information is accurate to avoid processing delays.
3. Complete the Provider Information section by entering the provider name, NPI number, specialty, and office contact details. All fields in this section are mandatory.
4. In the Medication Information section, indicate the medication name and strength. Specify whether this is a new start for the medication and detail any directions for use.
5. Fill in the Clinical Information by selecting the appropriate diagnosis from the options provided. If your diagnosis is not listed, include it under 'Other diagnosis' and provide the necessary ICD-9/10 codes.
6. Answer the question regarding the patient's medication history accurately to provide context for the request. Include any additional comments or relevant information that could assist in the review process.
7. Review all entered information for completeness and accuracy. Make sure that no required section is left blank, as this could lead to denial of the request.
8. Once all sections are completed, save your changes. You can then download, print, or share the document as needed for submission.

Complete your FlexPen Prior Authorization Request Form online to ensure timely processing.