Get Prior Authorization Request Form - Optumrx

Approval from a health plan that may be required before you get a service or fill a prescription in order for the service or prescription to be covered by your plan.

A prior authorization pharmacist works specifically with the pre-approval process of filling prescribed medication orders to ensure the proper insurance coverage and efficacy for the drugs used. In this career, you work with patients as well as clinical staff, who relay prescription information from a provider.

The prior authorization process gives your health insurance company a chance to review how necessary a certain medication may be in treating your medical condition. ... To avoid paying the full cost for medications that are not covered, ask your doctor if the medications you're taking are covered under your plan.

A prior authorization (PA), sometimes referred to as a pre-authorization, is a requirement from your health insurance company that your doctor obtain approval from your plan before it will cover the costs of a specific medicine, medical device or procedure.

UnitedHealthcare requires prior authorization for certain covered health services. In general, your network primary physician and other in-network providers are responsible for obtaining prior authorization before they provide these services to you. ... To obtain prior authorization, call the number on your ID card.

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.

Now, when a prescription comes into their PMS electronically, the system determines whether a PA is required and then transmits that PA request immediately to the physician. The pharmacy can do it all online without paper or faxes or phone calls.

To obtain prior authorization, call the number on your ID card. This call starts the utilization review process.

Health care providers usually initiate the prior authorization request from your insurance company for you. However, it is your responsibility to make sure that you have prior authorization before receiving certain health care procedures, services and prescriptions.