OptumRx Medication Prior Authorization Request 2013 free printable template

Prior Authorization Request Form Fax Back To: 1-800-853-3844 Phone: 1-800-711-4555 5 AM 7 PM PST M-F Prior Authorization Form Patient Information Patient s Name: Insurance ID: Date of Birth: Height:

How to fill out OptumRx Medication Prior Authorization Request

How to fill out OptumRx Medication Prior Authorization Request

1. Obtain the OptumRx Medication Prior Authorization Request form from the OptumRx website or your healthcare provider.
2. Fill out the patient information section, including the patient's name, date of birth, and insurance details.
3. Provide the prescriber’s information, including name, contact details, and NPI number.
4. List the medication needing prior authorization, including the dosage and frequency.
5. Select the appropriate diagnosis code that corresponds to the medication being requested.
6. Include any relevant clinical information and supporting documentation that justifies the need for the medication.
7. Sign and date the request form, either electronically or by hand.
8. Submit the completed request form to OptumRx through the designated submission method (fax, email, or online portal).
9. Keep a copy of the submitted request for your records and follow up on the status.

Who needs OptumRx Medication Prior Authorization Request?

1. Patients who are prescribed certain medications that require prior authorization by OptumRx.
2. Healthcare providers who are prescribing medications that fall under the prior authorization criteria.
3. Pharmacists who need to verify coverage and authorization status of the prescribed medications.

People Also Ask about

Is OptumRx owned by UnitedHealthcare?

OptumRx and BriovaRx are subsidiaries of UnitedHealth Group. UnitedHealthcare and the dimensional U logo are trademarks of UnitedHealth Group Incorporated.

How do I appeal a prior authorization denial OptumRx?

Call OptumRx customer service at 888-239-1301 or. Call the OptumRx prior authorization team at 800-711-4555 or. Have your provider fax OptumRx at 844-403-1028.

What happens if prior authorization is denied?

What happens if prior authorization is denied? If your insurance company denies pre-authorization, you can appeal the decision or submit new documentation. By law, the insurance company must tell you why you were denied. Then you can take the necessary steps to get it approved.

How do I appeal OptumRx denial?

Contact OptumRx at 1-800-613-3591 extension 9, Monday through Friday, 6 AM – 4 PM PT, or your OptumRx Provider Liaison; or the Call Center at 800-424-5815 to request a reimbursement price.

How do I file an appeal with OptumRx?

Contact OptumRx at 1-800-613-3591 extension 9, Monday through Friday, 6 AM – 4 PM PT, or your OptumRx Provider Liaison; or the Call Center at 800-424-5815 to request a reimbursement price.

What is the fax number for OptumRx appeal?

Please have the doctor or a qualified member of the office staff complete the next page(s) and fax the completed form to 1-844-403-1024. If you have questions or want to speak with an Optum Rx Prior Authorization Advocate, call 1-800-711-4555.

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What is OptumRx Medication Prior Authorization Request?

OptumRx Medication Prior Authorization Request is a process used by healthcare providers to obtain approval from OptumRx before a particular medication is covered under a patient's insurance plan.

Who is required to file OptumRx Medication Prior Authorization Request?

Healthcare providers such as physicians or pharmacists are typically required to file the OptumRx Medication Prior Authorization Request on behalf of their patients.

How to fill out OptumRx Medication Prior Authorization Request?

To fill out the OptumRx Medication Prior Authorization Request, healthcare providers need to complete a form that includes patient information, medication details, diagnosis, and the reasons why the medication is needed.

What is the purpose of OptumRx Medication Prior Authorization Request?

The purpose of the OptumRx Medication Prior Authorization Request is to ensure that medications prescribed to patients are medically necessary and to manage costs by approving only those that meet specific criteria.

What information must be reported on OptumRx Medication Prior Authorization Request?

Information that must be reported includes patient demographics, insurance details, the medication being requested, dosage, diagnosis, relevant medical history, and justification for the medication.