Get Optumrx Taltz Prior Authorization Request Form 2018-2025

This guide provides step-by-step instructions on how to complete the OptumRx Taltz Prior Authorization Request Form online. By following these clear and supportive guidelines, users can efficiently submit their requests while ensuring all necessary information is included.

Follow the steps to complete the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in the provided editor.
2. Fill out the member information section, including the member's name, insurance ID, date of birth, and contact details. Ensure all fields are completed to prevent processing delays.
3. Provide the provider information by entering the provider's name, NPI number, office phone, fax number, and office address. Verify this information is accurate.
4. In the medication information section, input the medication name, strength, and directions for use. Indicate if you are requesting the brand version of the medication.
5. Select the appropriate diagnosis from the provided options and include any relevant ICD-10 codes for clarity.
6. Answer the clinical questions regarding prescription details, including whether Taltz is prescribed by a dermatologist and any previous medication failures.
7. If this is a reauthorization request, provide information regarding the patient's clinical response to prior therapy with Taltz.
8. Use the comment section to include any additional relevant information such as other treatments tried, comments about the patient’s condition, or any specifics that may assist in the review.
9. Review all entered information for accuracy. Save your changes as needed, then you can download, print, or share the completed form directly from the editor.

Start completing your forms online today to streamline the authorization process.