Get Optumrx Orx5262 2014-2025

This guide provides a comprehensive overview of the OptumRx ORX5262 form, designed for users seeking reimbursement for medications purchased at retail cost. By following the outlined steps, individuals can efficiently complete the form online, ensuring all necessary information is accurately submitted.

Follow the steps to complete the OptumRx ORX5262 form online.

1. Click ‘Get Form’ button to download the form and open it in your preferred digital document editor.
2. Begin by filling out the member information section. Enter the Member ID found on your ID card, the health plan name, group or employer name, health plan state, last name, first name, middle initial, mailing address, city, state, ZIP code, date of birth (in mm/dd/yyyy format), and gender.
3. Provide the details for the prescribing physician and dispensing pharmacy. This includes the names and phone numbers of both the prescribing physician and the pharmacy where the medication was dispensed.
4. In the reason for request section, select the appropriate options based on your situation. Ensure that you check all options that apply, as this will help clarify your request.
5. Read and complete the acknowledgment statement carefully. If you are the authorized representative, ensure you have the appropriate documentation to submit with the form.
6. Attach the original pharmacy receipts for each medication, ensuring they contain all required information listed in the form's checklist.
7. Print a second page of the form if necessary and ensure all pages are filled out accurately.
8. Send the completed form along with the pharmacy receipts to the OptumRx Claims Department at the specified address. Ensure that you have provided all necessary documentation to avoid delays.
9. After submitting, consider saving changes, downloading a copy for your records, and optionally sharing the form with other relevant parties if necessary.

Start filling out the OptumRx ORX5262 online today to ensure your medication reimbursement requests are processed smoothly.