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Prior Authorization Request Form Fax Back To: (800) 853-3844 Phone: (800) 711-4555 5 AM 7 PM PST M-F Specialty Prior Authorization Request Form Patient Information Patient s Name: Insurance ID: Date
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What is optumrx enrollment form?
The optumrx enrollment form is a document that individuals must fill out to enroll in the OptumRx prescription drug program.
Who is required to file optumrx enrollment form?
Any individual who wants to participate in the OptumRx prescription drug program is required to file the optumrx enrollment form.
How to fill out optumrx enrollment form?
To fill out the optumrx enrollment form, you need to provide personal information such as your name, address, date of birth, and insurance information. You may also need to indicate your preferred pharmacy and choose a prescription drug plan.
What is the purpose of optumrx enrollment form?
The purpose of the optumrx enrollment form is to collect necessary information from individuals who wish to participate in the OptumRx prescription drug program in order to process their enrollment.
What information must be reported on optumrx enrollment form?
The optumrx enrollment form typically requires individuals to report personal information such as their name, address, date of birth, insurance information, preferred pharmacy, and prescription drug plan choice.
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