Get - Optima Health Providers

Filling out the Optima Health Providers form accurately is essential for the approval process of pharmacy prior authorization requests. This guide provides clear, step-by-step instructions to help users navigate each section of the form effectively.

Follow the steps to complete the Optima Health Providers form online.

1. Press the ‘Get Form’ button to obtain the form and open it for editing. Ensure you have a reliable internet connection to facilitate a smooth process.
2. Begin by selecting the drug requested from the list provided. Make sure to check only one option between ™ (alirocumab) or ™ (evolocumab).
3. Fill in the diagnosis section. Indicate whether the patient has a diagnosis of clinical atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia (if requesting ) by selecting the appropriate options.
4. Complete the required medical notes section. It is essential to provide supporting medical information as mentioned in the guidelines.
5. List the prescribing medical professional’s name and signature. This must be a handwritten signature; printed stamps are not acceptable.
6. Enter the prescriber’s contact information, including their phone and fax number. Double-check for accuracy to prevent any delays.
7. Document the prescriber’s DEA/NPI number to ensure proper identification.
8. Review all filled information for accuracy and completeness. Once verified, you can save the changes, download the document, print it, or share it as needed.

Complete the Optima Health Providers form online to ensure thorough processing of pharmacy prior authorization requests.