Get Professionals Optumrx

Filling out the Professionals Optumrx form is a straightforward process that requires careful attention to detail. This guide will walk you through each section of the form to ensure that your prior authorization requests are submitted accurately and efficiently.

Follow the steps to complete the Professionals Optumrx form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member information in the designated fields. This includes the member's name, insurance ID number, date of birth, and contact information.
3. Fill out the provider information. Provide the provider's name, NPI number, office phone, fax, and street address, along with the city, state, and zip code.
4. In the medication information section, specify the medication name, strength, and directions for use. Ensure to check the box if you are requesting the brand medication and if the request is for continuation of therapy.
5. Select the relevant clinical information. Indicate the diagnosis by checking the appropriate option and including any other diagnosis with the corresponding ICD-10 codes.
6. List any medications the patient has previously tried and had a failure, contraindication, or intolerance to, marking those that apply.
7. Specify the requested quantity of medication per month and the reason for any quantity limit requests. Check the appropriate reasons provided.
8. Include any additional comments or important clinical information that the provider believes is necessary for the review.
9. Review all entered information for accuracy and completeness before submitting the request.
10. Once completed, save the form changes and consider downloading, printing, or sharing the form as needed.

Start completing your Professionals Optumrx document online today.