Get Prior Authorization Request Form (page 1 Of ... - Optumrx.com

Completing the Prior Authorization Request Form online is essential for ensuring that users receive necessary medications covered by their insurance plans. This guide will walk you through each section of the form, providing clear instructions tailored to meet your needs.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the Prior Authorization Request Form and open it in the designated editor.
2. Fill in the member information. This section requires details such as the member's name, insurance ID number, date of birth, and phone number. Ensure all fields are completed accurately to facilitate processing.
3. Provide the provider information. Include the provider's name, NPI number, and office contact details to ensure proper identification and communication.
4. Complete the medication information section. Specify the medication name, strength, dosage form, and indicate if you are requesting the brand. Also, provide directions for use and answer the continuation of therapy questions as needed.
5. In the clinical information section, select the diagnosis related to the request and answer detailed questions regarding the member's medication history, including any previous treatments and their outcomes.
6. If applicable, address reauthorization questions, especially for inflammatory bowel disease and irritable bowel syndrome, by providing relevant details regarding past treatment courses and responses.
7. Respond to the quantity limit requests section clearly, detailing the amount requested per month as well as any relevant diagnoses related to the medication use.
8. Finally, review all sections of the form to ensure completeness and accuracy. Save any changes made, and you have the option to download, print, or share the form as needed.

Start completing your Prior Authorization Request Form online today to ensure your medication needs are met promptly.