Loading
Get Optumcare Primary Care Provider (pcp) Referral Form 2016-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the OptumCare Primary Care Provider (PCP) Referral Form online
The OptumCare Primary Care Provider (PCP) Referral Form is essential for facilitating necessary referrals to specialists. This guide will walk you through each section of the form, ensuring you provide all required information accurately and efficiently.
Follow the steps to complete the form successfully.
- Press the ‘Get Form’ button to access the form and open it in your editing tool.
- In Section 1, enter the member information. Be sure to fill in the required fields, including the member's name, ID number, address, date of birth, and telephone number. If applicable, include the telephone extension.
- Move to Section 2 to provide the primary care provider (PCP) information. Fill in the PCP's name, telephone number, and fax number, along with the address and any relevant tax identification and national provider numbers. Also, indicate the in-network provider specialty if it differs from the general PCP.
- Next, proceed to Section 3 to list the referred specialist's information. Enter the specialist's name and required identifiers, including their tax identification number, national provider number, telephone number, and their address. Include the fax number and any relevant specialty information.
- Continue to Section 4 where you will document the referring specialist's details. Similar to previous sections, fill in their name, identifiers, address, telephone number, and fax number, ensuring that all required fields are completed.
- In Section 5, provide the referral for evaluation and treatment information. Specify the start date for the referral, the referring diagnosis, and indicate the type of request by checking either ‘Initial Referral Request’ or ‘Subsequent Referral Request.’
- Once all sections are completed, save your changes, and then choose to download, print, or share the form as needed. Remember to submit the referral via the suggested methods.
Complete your OptumCare Primary Care Provider (PCP) Referral Form online with confidence!
To submit a prior authorization to Optum, you must complete the OptumCare Primary Care Provider (PCP) Referral Form and attach any required documentation. Once you fill out the form, you can submit it online through Optum's provider portal or send it via fax. Ensure you follow any specific guidelines outlined by Optum to facilitate a smooth authorization process.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.