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Get Optumrx & Prior Authorization Request Form 2014
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How to fill out the OPTUMRx & Prior Authorization Request Form online
Filling out the OPTUMRx & Prior Authorization Request Form online is a straightforward process that enables users to submit necessary authorization requests efficiently. This guide provides step-by-step instructions to help users complete the form correctly and ensure all required information is provided.
Follow the steps to fill out the OPTUMRx & Prior Authorization Request Form online
- Click the ‘Get Form’ button to access the form and open it in the editor.
- Begin by entering the member's information, including the member's name, insurance ID number, date of birth, and contact details. Ensure all required fields are filled accurately.
- Next, provide the provider's information. Fill out the provider's name, National Provider Identifier (NPI) number, office phone, address, specialty, and fax number.
- In the medication information section, enter the medication name and strength. Indicate whether this medication is a new start and specify the dosage form and directions for use.
- Proceed to the clinical information section by selecting the appropriate diagnosis from the provided list and answering any additional questions related to that diagnosis.
- Complete the reauthorization questions if applicable, ensuring all sections specific to the diagnosis are addressed.
- For quantity limit requests, specify the quantity requested per day and provide a reason for surpassing any plan limitations.
- In the final comments section, include any additional diagnoses, symptoms, medications tried, or any pertinent information that will assist in the review process.
- Once all fields are completed, review the form for accuracy. Save changes, download, print, or share the completed form as needed.
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To talk to someone at OptumRx, you can call their customer service team or use their online chat feature for immediate assistance. They are equipped to help you with inquiries related to the Prior Authorization Request Form, claims, or any other questions you have. OptumRx aims to provide you with reliable support every step of the way.
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